We consider applicants for all positions without regard to race, color, national origin, age, religion, sex, maritalstatus, veteran or military status, the presence of a medical condition, disability, or any other legally protected status.

An Equal Opportunity Employer

Date of Application: Social Security Number:

Middle Name:First Name: Last Name:

Address

City State Zip Code

Home Phone Number: Work Phone Number:

Other Address where you may be reached:

email

Posi

tion

Dat

a Position(s) for which you are applying:

For Elementary positions, grade levels in order of preference:

Credentials included with application (check all that apply):

Resume All Teaching and Professional certificates (front & back, if appropriate) All Transcripts showing degrees

Date you can begin work: Have you been employeed by Rio Vista ISD in the past? No Yes

If yes, provide dates of employment:

Edu

catio

n / T

rain

ing Name and location of schools attended Course of Study

Major / MinorDiploma, Degree, or

Certificate HeldYear graduated

(college only)

Rio Vista ISD Employment Application for Professional Personnel Page 1 of 4

Pers

onna

l Dat

a

Other name(s) that may appear on records (only for reference checks)

EMPLOYMENT APPLICATION FOR PROFESSIONAL PERSONNEL

Cer

tific

atio

nCertificate(s) or liscense(s) held: (mark all that apply)

None Valid Texas Valid other state:

Texas Emergency Texas One-Year Certificate

Expires: Expires:

Texas Temporary Administrative Certificate

Area(s) of Specialization: (mark all that apply)

Administrator

Elementary

All-Level Art

Librarian

Vocational Specify:

Superintendent

Elementary & Kindergarten

All-Level Health & PE

Mid-Management Adminstrator

Secondary (Junior / Senior High)

All-Level Music

Subject Area:

Nurse

Visiting Teacher

SupervisorSpecify: Other

Tea

chin

g E

xper

ienc

e Reason forleavingDates TaughtAssignmentName and location of schools

List teaching experience beginning with the most recent year.

Oth

er E

xper

ienc

e

Reason forleavingDates employedPosition / AssignmentCompany / Firm Name & Location

Provide a list of all other jobs or administrative positions, outside of education, you have held in the past 10 years.

Name:

Rio Vista ISD Employment Application for Professional Personnel Page 2 of 4

Prof

essi

onal

Dat

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

Papers / Articlespublished:

Seminars /Workshopsconducted:

Other relatedprofessionalactivities:

Gen

eral

Info

rmat

ion Do you have a relative who serves on the Rio Vista ISD Board of Trustees?

If yes, provide the relative'sname and relationship:

Have you ever been convicted of or plead guilty or no contest (nolo contendre) to a felony or offense involving moral turpitude(including, but not limited to: theft, rape, murder, swindling and indecency with a minor)?

If yes, please state where, when, and the nature of the offense; indicate whether the charges were dismissed as a condution ofprobation, suspension or deferred adjudication.

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

Ref

eren

ce

Please list references the district can contact regarding your work history. Please include all managers or supervisers whoevaluated or supervised your performance at your last two employers.

Phone NumberPosition / TitleSchool District NameName of Reference and Address

Name:

Rio Vista ISD Employment Application for Professional Personnel Page 3 of 4

No Yes

I hereby affirm that all information provided in this application is true and accurate to the best of myknowledge and understand that any deliberate falsifications, misrepresentations, or omissions of fact may begrounds 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 myprevious employment and any pertinent information they may have, personal or otherwise, and release allsuch parties from liability from any damage that may result from furnishing same to you.I understand that the district is required by Texas Education Code 22.083 to obtain criminal history recordinformation on applicants selected for employment.

This application becomes the property of the district. The district reserves the right to accept or reject it. Allapplications are placed in the inactive file as of December 31st each school year. In the event you wish yourfile to remain active for the ensuing school year, it will be necessary to notify the personnel office. Allinactive files are destroyed after the second year.

Name:

Rio Vista ISD Employment Application for Professional Personnel Page 4 of 4

Signature of Applicant

Date: