PINEYWOODS COMMUNITY ACADEMY

Employment Application for
PROFESSIONAL PERSONNEL


We consider applicants for all positions without regard to race, color, national origin, age, religion, sex, marital status, veteran or military status, disability or any other legally protected status. - AN EQUAL OPPORTUNITY EMPLOYER



Position Applied For:
Professional Staff

Date: Tuesday, June 27, 2017














Name of School Location Course of Study and major/minor Diploma, degree, certificate, or license held


Resume 
All teaching and professional certificates or licenses 
Copies of all transcripts showing degrees (an official transcript will be required upon hiring) 


Yes  No 



None 
Valid Texas 
Valid Other State  
Texas Emergency 
Texas One-Year: Expires  
Texas Temporary Administrative: Expires  



Please provide a complete list of all positions you have held in the past 10 years. List the most recent first. Attach additional sheets, if necessary. Attach resume, if available.
Name of School Location Type of Assignment/Title Dates Taught Reason for Leaving

Please list relevant professional activities. Omit references to organizations that would reveal race, age, ethnic origin or religion.




Please provide a list of all other jobs or administrative positions you have held in the past 10 years. Attach additional sheets, if necessary. Attach resume, if available.
Employer Location Position/Title Dates Employed Reason for Leaving


Yes  No 


Yes  No 

(A felony conviction is not an automatic bar to employment. The district will consider the nature, date and relationship between the offense and the position for which you are applying.)


Please list references the district can contact regarding your work history. Include all managers and supervisors who evaluated or supervised your performance at your last two employers.
Name of Reference School District/Firm Name Mailing Address Position/Title Phone Number (with area code)

I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge and understand that any deliberate falsifications, misrepresentations or omissions of fact may be grounds for rejection of my application or dismissal from subsequent employment.

I authorize the above-listed references to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all such parties from liability for any damage that may result from furnishing the same to you.

(A)I understand that the agency to which I am applying may use my Social Security Number (SSN) for tracking purposes and for identification. This is in accordance with Federal Law U.S.C. 552a Section 7 (b)

Signature:
Date: Tuesday, June 27, 2017

This application becomes the property of the district. The district reserves the right to accept or reject it. This application shall be considered active for 18 months. If you have not received a response during this time period, you may reapply or reactivate your application.