Employment Application

Interested in becoming a part of a great staff at an outstanding
educational institution? Fill out the form below to apply for employment.
We consider applicants for all positions without regard to race, color, national origin, age, religion, sex, marital, or veteran status, the presence of any medical condition, disability, or any other legally protected status.

APPLICANT INFORMATION
Last Name:   First Name:   Middle:  
Mailing Address:   City/State:   ZIP:  
Phone #:   E-Mail Address:  
List any other names used if different from name on this application:   

POSITION INFORMATION
List exact title of position or type of work and location for which you wish to apply: 
Do you have any relatives working for PCA or on the school board? If so, list name and relation: 
Full-time       Part-time      Temp/Project  Date Available: 
Do you speak a language other than English?   Yes  No
If yes, what languages(s)?          How fluently?
Have you been discharged, not re-employed or resigned from a teaching position at a time when evidence existed to support a recommendation of termination or nonrenewal of your employment during the past 6 years?Yes  No
If yes, where?    When?    Why?


CERTIFICATION INFORMATION
Please check certified fields:
Elementary (K-5).     Grades in order of Preference: 1    2    3
Junior High (6-8).     Subject Preference: 1    2    3
Special Education.     List Specialty: 1    2    3
List below teaching fields/endorsements AS THEY APPEAR ON YOUR CERTIFICATE:
Other than the certified fields above, list all the subject areas with 12 or more semester hours on your transcript:
Subject  Hrs.     2nd  Hrs.    3rd  Hrs.

PROFESSIONAL REFERENCES: Please list below references who may be contacted regarding your work history. Please include all principals, managers, and supervisors at the last two districts or employing organizations who evaluated or supervised your performance.
FULL NAMESCHOOL
DISTRICT/FIRM		POSITION/TITLEEMAILPHONE
1  
2  
3  

EDUCATION: (NOTE: Applicants are required to provide proof of diploma, degree, transcripts, licenses, certifications and registrations.)
Type of SchoolName and Location of SchoolDates Attended Date GraduatedExpected Grad. DateSem/Clock Hours Completed Type of Diploma or DegreeMajor/Minor Fields of Study
Undergraduate Colleges or Universities
Graduate Schools
Tech, Vocational,
or Bus. Schools

CRIMINAL BACKGROUND: All Texas school districts are authorized to obtain any criminal history record information relating to an applicant for employment. (Texas Education Code Section §22.083)

Have you been convicted of a felony, an offense of moral turpitude, or any other offense other than a minor traffic infraction? If yes, please explain the circumstances. Yes No

Have you been convicted of a felony, an offense of moral turpitude, or any other offense other than a major traffic infraction and received probation? If yes, please explain the circumstances. Yes No

Has any court received a plea of guilty or a plea of nolo contendere (no contest) from you for any felony, offense involving moral turpitude, or any other offense other than a minor traffic infraction and placed you on probation? If yes, please explain the circumstances. Yes  No

(Conviction of a crime, or the imposition of deferred adjudication is not an automatic bar to employment. The District will consider the nature of the offense, the date of the offense, and the relationship between the offense and the position for which you are applying.)

I hereby certify that the information presented in this application to the best of my knowledge is true, accurate and complete. Any falsification, misrepresentation or omission of this record will be sufficient cause for disqualification or later termination. Furthermore, it is understood that this application becomes the property of Pineywoods Community Academy (PCA) which reserves the right to accept or reject it. I hereby authorize PCA to contact any references listed, and to obtain any criminal history record information relevant to this application for employment from any pertinent source in accordance with the provisions of the Texas Education Code 22.081 et. Seq. and I further authorize any law enforcement agency, including, but not limited to any police department of the Department of Public Safety as well as the Texas Department of Corrections to furnish PCA any such record. References, placement folder information and information which becomes a part of this record may be revealed to all persons who participate in the selection of employees.

  I agree with the above statements. Today's Date:  
  I understand that there is a background check authorization that must be filled out and submitted to the office. This form may be picked up from the office, or to download this form, please click here.

If you download the form, you can mail it to or drop it off at 602 S. Raguet, Lufkin, TX. 75904


 
   

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