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T HREE WAY INDEPENDENT SCHOOL DISTRICT

247 CR 207, STEPHENVILLE, TEXAS 76401 254-965-6496 FAX 254-965-3357

APPLICATION FOR EMPLOYMENT

Date of Application __________________ Social Security No. ____________________________________________ Name ____________________________________________________________________________________________ Last First Middle I. Present Address ____________________________________________________________________________________ Street/Box City State Zip Permanent Address__________________________________________________________________________________ Street/Box City State Zip Home Phone No. _________________ Cell Phone No. _________________Work Phone No.______________________ Position for which you are applying ____________________________________________________________________ E-mail address _____________________________________________________________________________________

EDUCATIONAL TRAINING – List High Schools and Colleges Attended School

Dates / / / / /

Degree/Diploma

Date Graduated

TEACHING EXPERIENCE (if applying for a teaching position) Name of School/Location

Years / / / / / / /

Grade/Subject

# of Months

Total years of experience____________________ It is the policy of Three Way ISD not to discriminate on the basis of race, color, national origin, sex, handicap, or age in providing employment, programs and service. Es la politica de Three Way no descriminar a nadie por su raza, color nacionalidad, sexo, incapapcidad o edad, en ofrecer empleos, programas y servicios.

AN EQUAL OPPORTUNITY EMPLOYER

EMPLOYMENT RECORD (other than teaching experience) Employer

Dates / / / / / / /

Position

Issue Date

Expiration Date

Location

List Certificates Certificate

State

In what activities are you most interested and could sponsor: _________________________________ __________________________________________________________________________________ School Name/City/Phone# where practice teaching was done __________________________________________________________________________________ Grade level and subject areas of practice teaching Please list any foreign languages spoken fluently:__________________________________________ REFERENCES Name

Address

Position

Phone No. H W C H W C H W C H W C

Have you ever been convicted of a felony or offense involving moral turpitude (including, but not limited to theft, rape, murder, swindling, and indecency with a minor)? YES __________ NO ___________ If yes, please state where, when, and the nature of the offense:________________________________________ _________________________________________________________________________________________ (Conviction of a felony 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.)