Full Name: (Please print) Last First Middle Maiden Name. Address: (Please print) Street City State Zip. Telephone Numbers: Home Cell Work

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1 9849 FM 2171 HCR 1 Box 48 Skellytown, Texas PARAPROFESSIONAL EMPLOYMENT APPLICATION General Information Position(s) for which you are applying: Date of Application: Full Name: (Please print) Last First Middle Maiden Name Address: (Please print) Street City State Zip Telephone Numbers: Home Cell Work Have you previously been fingerprinted/registered with the Department of Public Safety for employment? Yes No Driver s License State: Date of Birth: Driver s License Number: Current Address: Do you have a relative who serves on the Spring Creek ISD Board of Trustees or is an employee of Spring Creek ISD? No Yes If yes, please provide the relative s name and relationship: Name of Relative Relationship Have you ever been convicted of, pled guilty or no contest (nolo contender) to, or received probation, suspension, or deferred adjudication for a felony or any offense involving moral turpitude (including, but not limited to, theft, rape, murder, swindling, and indecency with a minor)? No Yes If yes, please state where, when, and the nature of the offense: Place/Location of Offense Date of Offense Nature of Offense:

2 Education Schools Attended: Name of School Dates of Attendance Course of Study Diploma, Degree or Certificate Year Earned

3 Work Experience Employer Name Address, Zip, Phone 1. Supervisor Dates Employed Position Reason for Leaving

4 Work References Full Name Mailing Address Relationship of Work Reference Address 1. Mailing: Telephone Number with Area Code 2. Mailing: 3. Mailing: Personal References Full Name Mailing Address Relationship of Personal Reference Address 1. Mailing: Telephone Number with Area Code 2. Mailing: 3. Mailing: Why are you interested in employment at Spring Creek Independent School District?

5 Verification 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 references listed on the previous page 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. I understand that the district is required by Texas Education Code to review criminal history of applicants. Signature Date Attach any additional information that will give us a more complete estimate of your training, experience, character, and related abilities. Copies of testimonials and letters of reference may be included with this application. A personal interview is required before appointment will be made. You may wish to submit your photograph with this application. (If photograph is not recent, or of poor likeness, so indicate.) This application will be placed on file for consideration when vacancies occur. It should be complete and accurate in every detail. In case of appointment, you will be notified at once. Incomplete applications will not be considered. Applicant must submit the following in order to be considered for any SCISD professional job vacancy: 1. Completed SCISD Paraprofessional Employment Application 2. Resume 3. Copy of transcript(s) 4. Completed Authorization to Request Criminal History Record 5. Signed/Dated Department of Public Safety (DPS) Computerized Criminal History (CCH) Verification Form Complete submissions must be mailed or ed to: Mandy Poer, Superintendent HCR 1 Box 48 Skellytown, Texas mandy.poer@region16.net Applicants for all positions are considered without regard to race, color, sex (including pregnancy), national origin, religion, age, disability, genetic information, veteran or military status, or any other legally protected status. Additionally, the district does not discriminate against an applicant who acts to oppose such discrimination or participates in the investigation of a complaint related to a discriminating employment practice. Spring Creek Title IX Coordinator: Mandy Poer, Superintendent

6 9849 FM 2171 HCR 1 Box 48 Skellytown, Texas AUTHORIZATION TO REQUEST CRIMINAL HISTORY RECORD Spring Creek ISD is required by law to obtain criminal history record information on all applicants for employment with the district (Texas Educational Code, Section ). The information requested below is necessary to obtain criminal history record information. PLEASE PRINT Full Name: Last First Middle (Not Initial) Social Security Number: - - Driver s License State: Driver s License Number: Sex: Female Male Date of Birth: Month Day Year Ethnicity: Black White Other: I understand the information I am providing about age, sex, and ethnicity will not be used to determine eligibility for employment, but will be used solely for the purpose of obtaining criminal history record information. Signature Date