PROFESSIONAL APPLICATION

PROFESSIONAL PERSONNEL Application:

It is the policy of White Oak Independent School District not to discriminate on the basis of race, color, natinal origin, sex, handicap, or age in its employment practices as required by Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Education Amendments of 1972; the Age Discrimination Act of 1975, as amended; and Section 504 of the Rehabilitation Act of 1973, as amended. For information about your rights or grievance procedures, contact the Title IX Coordinator/Section 504 Coordinator at (903) 291-2200.
Personal Information:
Full Name*

First NameMiddle NameLast Name
Maiden Name
Date of Application*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail*
Employment Desired:
Former White Oak ISD Employee:*

YesNo
If yes, From:

MonthDayYear
To:

MonthDayYear
Do you have a relative who is a member of the White Oak ISD Board of Education or who is employed in any capacity in the White Oak school district?*

YesNo
If yes, please give the name of relative and relationship:
Are you a receiving funds from the Teacher Retirement System (TRS)?*

YesNo
If yes, would the district be required to pay TRS a surcharge if you are employed?*

YesNo
Are you currently a member of the Teacher Retirement System?*

YesNo
Campus of position for which you are applying:*

Primary (PK-2)Intermediate (3-5)Middle School (6-8)High School (9-12)AdministrationSpecialty Area
Preferred Teaching Areas: Please include grades and/or subjects:
1st Choice
Preferred Teaching Areas: Please include grades and/or subjects:
2nd Choice
Preferred Teaching Areas: Please include grades and/or subjects:
3rd Choice
Preferred Teaching Areas: Please include grades and/or subjects:
4th Choice
Preferred Coaching Areas:
1st Choice
Preferred Coaching Areas:
2nd Choice
Administration or Specialty Area please specify:
i.e., Counselor, ESL, Librarian, Nurse, Special Ed
Education:
Name of School & Location
College or University
Dates Attended:
Year Graduated
Type of Degree
Course of Study Major/Minor Fields:
Name of School & Location
College or University
Dates Attended:
Year Graduated
Type of Degree
Course of Study Major/Minor Fields:
Name of School & Location
College or University
Dates Attended:
Year Graduated
Type of Degree
Course of Study Major/Minor Fields:
Teaching Experience

List beginning with most recent years. Beginning teachers should list student teaching.
Name of School & Location
Grades/Subject Taught
Reason for Leaving?
Number of Years
Started Teaching

MonthDayYear
Ended Teaching

MonthDayYear
Name of School & Location
Grades/Subject Taught
Reason for Leaving?
Number of Years
Started Teaching

MonthDayYear
Ended Teaching

MonthDayYear
Name of School & Location
Grades/Subject Taught
Reason for Leaving?
Number of Years
Started Teaching

MonthDayYear
Ended Teaching

MonthDayYear
Name of School & Location
Grades/Subject Taught
Reason for Leaving?
Number of Years
Started Teaching

MonthDayYear
Ended Teaching

MonthDayYear
TOTAL CREDITABLE YEARS TEACHING
Full-time teaching in college, public school, or in an accredited private school is creditable
Other Work Experience:
Employer

Name

Address

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Supervisor Name
Start Date

MonthDayYear
End Date

MonthDayYear
Employer

Name

Address

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Supervisor Name
Start Date

MonthDayYear
End Date

MonthDayYear
Employer

Name

Address

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Supervisor Name
Start Date

MonthDayYear
End Date

MonthDayYear
References:
Reference 1
Name of Reference
School District/Firm Name
Email Address:
example@example.com
Years Acquainted
Phone Number

Area CodePhone Number
Phone Number

Area CodePhone Number
Reference 2
Name of Reference
School District/Firm Name
Email Address:
example@example.com
Years Acquainted
Phone Number

Area CodePhone Number
Phone Number

Area CodePhone Number
Reference 3
Name of Reference
School District/Firm Name
Email Address:
example@example.com
Years Acquainted
Phone Number

Area CodePhone Number
Phone Number

Area CodePhone Number
General Information:
Do you have any physical or health impairments that would limit your ability to perform the job for which you are applying*

YesNo
If yes, please explain:
Are you currently under contract with another school district?*

YesNo
If yes, where:
Why did you leave your last position, or why do you wish to leave your present position?
Are you fluent in other languages?*

YesNo
If yes, please explain:
Have you ever been asked to resign or been discharged through due process from any position, teaching or otherwise?*

YesNo
If yes, please explain:

Pre-Employment Affidavit for Applicant
For purposes of this affidavit:

Adjudication and conviction refer to conviction, plea of guilty and no contest (nolo contendre), probation, suspension, or deferred adjudication.

Charge refers to a formal criminal charge as documented by primary charging instrument (a complaint, information, or indictment) under the Texas Code of Criminal Procedure.

Inappropriate relationship refers to the crime of improper relationship between educator and student in Texas Penal Code section 21.12 and other inappropriate relationship as determined by the State Board for Educator Certification.

I declare the following:
1. I have never been charged with, adjudicated for, or conficted of having an inappropriate relations with a minor.
2. I have been charged with, adjudicated for, or convicted of having an inappropriate relationship with a minor. The charge, adjudication, or conviction was determined to be false. The following are all of the relevant facts pertaining to the charge, adjudication, or confiction:
3. I have been charged with, adjudicated for, or convicted of having an inappropriate relationship with a minor. The charge, adjudication, or conviction was determined to be true. The following are all of the relevant facts pertaining to the charge, adjudication, or conviction:
_________________________________________________

Declaration of Applicant

The following affidavit is offered to satisfy the requirement of Texas Education Code section 21.009 for pre-employment affidavit, in accordance with Texas Civil Practices and Remedies Code section 132.001. An applicant who is offered employment will be asked to complete a notarized affidavit attesting to the same.
Please choose which applies 1, 2, or 3*
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Executed in County, State of Texas

on the Date, Month, Year
Signature of Declarant*

Clear
I understand that the date of birth I am providing will not be used to determine eligibility for employment but will be used solely for the purpose of the pre-employment affidavit.*

*This form will be removed from the application and filed separately in the HR Office.

Approved by the Texas Commissioner of Education, October 2017.

Cover Letter & Resume (Optional):
Cover Letter

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Resume

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Send Application:

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By clicking the submit button below, 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 to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherweise, and release all such parties from liability for any damage that may result from furnishing the same to you. I further authorize the district to use DPS or other authorized agency to fingerprint me and rely on the information obtained through this identity process.

I understand that the district is required by the Texas Education Code 22.083 and 22.085 (SB9) to obtain a criminal history record on all applicants the district may employ.

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 a period of twelve (12) months. Any applicant wishing to be considered for employment beyond this time period may call and request that the application remain active.
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PROFESSIONAL PERSONNEL Application:

Personal Information:

Employment Desired:

Education:

Teaching Experience

Other Work Experience:

References:

General Information:

Pre-Employment Affidavit for Applicant

Cover Letter & Resume (Optional):

Send Application: