Name (print) - Dallas County Schools

612 N. Zang Blvd. Dallas, Texas 75208 214-944-4545 (Phone) 214-944-4564 (Fax) Website: www.dcschools.com Email: [email protected]

APPLICATION FOR EMPLOYMENT ACKNOWLEDGEMENT I hereby affirm that all information provided within this application is true, accurate and complete to the best of my knowledge, and understand that any falsification, misrepresentation or omission of fact may be grounds for rejection of my application or dismissal from subsequent employment. I authorize all references and previous employers listed within this application to give Dallas County Schools any and all information concerning my previous employment and any pertinent information that they may have, personal or otherwise, and release all such parties from any liability for use of such information. I understand that Dallas County Schools is required by Texas Education Code Chapter 22 and Texas Government Code Chapter 411 to obtain criminal history record information and submit fingerprint information to the Texas Department of Public Safety and the Texas State Board of Educator Certification on applications selected for employment. I also understand that Dallas County Schools will conduct a background check on all applicants and may review my driving record in order to determine employment eligibility in accordance with Dallas County Schools Policy. I understand that this application becomes the property of Dallas County Schools, and it reserves the right to accept or reject it. This application shall be considered active for a period of time not to exceed 90 days. If I wish to be considered for employment beyond this time period, I must inquire as to whether or not applications are being accepted at that time. I agree to submit to a pre‐employment, post‐offer drug and/or alcohol test.

____________________________________________________________________________ Signature of Applicant Name (print):

Date

__________________________________________________________________

Position Applied For: _______________________________ Job Posting #: _____________________________ Dallas County Schools is an Equal Opportunity Employer and does not discriminate in its employment decisions on the basis of race, religion, color, national origin, gender, sex, age, military status, disability, genetic information, or on any other basis that would be in violation of any applicable federal, state, or local law. Unless otherwise specifically stated, all DCS employees are at-will.

Page 1 of 4 Dallas County Schools – Application for Employment 9/9/2015

PERSONAL DATA How did you hear about this job? (Check one) ☐DCS Employee ☐DCS Website ☐Newspaper ☐TWC ☐Billboard ☐Email Blast

Other_________________________ Position for which you are applying: ________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Name (Last, First, Middle) Social Security # Date of Birth _________________________________________________________________________________________________________________________ Current Street Address Apt. City State Zip _________________________________________________________________________________________________________________________ Home Phone Other Phone Email Address _________________________________________________________________________________________________________________________ Driver’s License/ID # Expiration Date Type/Class Endorsements State If employed, can you provide proof of U.S. citizenship or right to work in the U.S.?

☐Yes

☐No

Are you 18 or older?

☐Yes

☐No

List all cities, counties, and states where you have lived: Cities Counties States _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Have you ever been issued a driver’s license or identification card from another state? ☐Yes ☐No If yes, list state(s) and dates: ________________________________________________________________________________________________ If you have changed your name, used an assumed name, nickname, etc., please list all of those names: _______________________________ _________________________________________________________________________________________________________________________ Do you have a relative who is currently employed by Dallas County Schools or a member of the Dallas County Schools Board of Trustees?

☐Yes ☐No If yes, please name the employee(s)/board member and your relationship to them: ___________________________________________________ Have you worked for Dallas County Schools before? ☐Yes ☐No If yes, list employee number, position(s), and dates of employment: ______________________________________________________________ Are you retired through TRS and receiving a monthly income? ☐Yes ☐No If yes, list the effective date of your retirement: ________________________________________________________________________________ Are you currently employed by another school district? ☐Yes ☐No If yes, list district and current position: ________________________________________________________________________________________ Have you submitted fingerprints to another school district and/or the Texas Department of Public Safety (DPS)? ☐Yes ☐No If yes, what district and when: _______________________________________________________________________________________________ Do you have a Texas School Bus Driver’s Certification? ☐Yes ☐No If yes, list expiration date and region: __________________________________________________________________________________________ **Please add additional pages as necessary if you need additional room to answer the questions above. Page 2 of 4 Dallas County Schools – Application for Employment 9/9/2015

BACKGROUND VERIFICATION Dallas County Schools evaluates the criminal history of employment applicants and employees in accordance with applicable law and DCS Policy Sections 11.007, 11.008, and 14.015. Copies of those policies may be obtained from the Human Resources Department or online at www.dcschools.com. 1.

Have you ever been convicted of a felony or Class A or B misdemeanor? ☐Yes ☐No *A “conviction” includes probation or deferred adjudication, a finding of guilt, or acceptance by the court of a plea of guilty or nolo contendere.

2.

Are there any pending criminal charges or proceedings against you?

3. 4.

Are you currently under any type of probation or other form of community/court supervision? If you are applying for a position that involves operating a DCS motor vehicle as part of the position’s job responsibilities: a. b.

☐Yes ☐Yes

☐No ☐No

Have you received any moving traffic violations within the last three (3) years? ☐Yes ☐No Has your driver’s license been suspended, revoked, cancelled, expired, or not renewed within the last three (3) years?

☐Yes

☐No

If you answered yes to any of the questions above, please list all convictions, charges, etc.; dates; and explain:** ________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ **Please add additional pages as necessary if you need additional room to answer the questions above.

Please read and verify the following statement: “I swear that I have fully disclosed to DCS any and all convictions or pending criminal charges or matters against me in accordance with DCS Policy Sections 11.007, 11.008, and 14.015. I understand that under Texas law, my fingerprints have been submitted to appropriate state and federal agencies for review. Pending the outcome of those results, I swear to the best of my knowledge that nothing in my results will prevent my employment with DCS. I understand that failure to make any required disclosure, or misrepresentation of any information regarding any conviction, pending criminal charge, suspension, revocation, or non-renewal will result in termination of employment.” Applicant Signature: _______________________________________________________________________________________________________

Page 3 of 4 Dallas County Schools – Application for Employment 9/9/2015

EDUCATION Select last grade completed:

1

2

3

4

5

6

7

8

9

10

11

12

□Diploma GED □College/Grad School

List all education since high school, including college, graduate, business, technical, trade, correspondence and/or military schools:**

School Name

City, State

From

To

Year

Year

Major/Minor Or Course Title

Certificate

Degree

WORK EXPERIENCE List all work history for the past ten (10) years, listing the most recent employer first:** Employer

Address/Phone

Job Position

Employment Dates

Reason Left

CDL Required

☐YES☐NO

☐YES☐NO

☐YES☐NO

☐YES☐NO

☐YES☐NO

REFERENCES

List three (3) work references who are familiar with the quality of your work, have worked directly with you, and have known you for at least two (2) years:** Name

Address

Phone #

Occupation

**Please add additional pages as necessary if you need additional room to answer the questions above Page 4 of 4 Dallas County Schools – Application for Employment 9/9/2015