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Smyer Independent School District - JH/HS

Professional Employees Application for Employment

Date of Application*
Date Available*
Title
Name* Please give full name: Last, First, Middle Initial, Maiden
Other names that may appear on records
Email:*
Confirm Email:
Present Address* Street Address or PO Box, City, State, Zip Code
Phone Number*
Position Desired* Please indicate grade level, subject matter or type of position you prefer
Educational Training* Please list High School, its location, and graduation year
Higher Education* Please list colleges attended, dates of enrollment, and degrees received.
Student Teaching* Please list the district, dates of student teaching, subject or level, name and address of supervising principals and cooperating teachers, and college professor who supervised.
Teaching Experiences Please list teaching experiences beginning with the most recent years. List school name and location, what your assignment was, the dates employed and reason for leaving.
Other Jobs Please list other jobs, outside education, that you have held in the past. List business name and location, your job details, the dates employed, and your reason for leaving.
Type of Certification held currently*
If you have no certification, have you satisfied the following requirements? EXCIT/TExES
If you still have required course work to finish, please list course(s) and dates expected to finish
If all requirements have been satisfied, has a formal application been submitted by the college to TEA? Please list college and date submitted.
Have you ever failed to be elected or been discharged from a teaching position?*
Are you currently under contract to another district?*
Have you ever been convicted of a felony or misdemeanor?*
If you answered yes to a felony or misdemeanor, please explain.
Have you ever been placed on probation or deferred adjudication?*
If yes, please explain.
What language, other than English, do you speak fluently?
Are you or your spouse related to any member of the Board of Trustees or the spouse of any board member of Smyer ISD?*
References* List names, mailing addresses, phone numbers, and positions of professional references who would have first-hand knowledge of your character, personality, and teaching ability. List at least one administrator for each of your teaching positions.
Have you ever failed to have a contract renewed with a school system?*
Have you ever been dismissed or terminated from employment with a school system?*
Have you ever resigned in lieu of proposed contract non-renewal or termination?*
Have you ever had a teaching credential denied, revoked, or suspended in any state?*
Within the last three years, have you ever been evaluated under the Texas PDAS as unsatisfactory in one or more domains or as below expectations in two or more domains?*
If you answered yes to any of the above 5 questions, you must explain.

In the following question, the term "conviction" includes a "no contest" or "nolo contendre" plea, probation, and deferred adjudication; the term "moral turpitude" includes without limitations, offenses involving theft or attempted theft of any kind, fraud of any kind, sexual offenses of any kind, assaultive offenses, bribery, perjury, drugs and alcohol offenses, offenses involving minors, or any other offense contrary to justice, honesty, modesty, or good morals.

Conviction of a felony or crime of moral turpitude is not an automatic bar to employment.  The District will consider the nature of the offense, the date of the offense, and the relationship between the offense and the position for which you are applying.

Have you ever been convicted of or pleaded nolo contendre to a felony or offense involving moral turpitude?*
Are you aware of any reasons you would not be able to perform the duties of the position for which you are making application?*
If the answser to one of the last two questions is YES, you MUST explain.
Pre-Employment Affidavit for Applicant
Pre-Employment Affidavit for Applicant* For purposes of this affidavit: Adjudication and conviction refer to a conviction, plea of guilty or no contest (nolo contendre), probation, suspension, or deferred adjudication. Charge refers to a formal criminal charge as documented by a 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 any other inappropriate relationship as determined by the State Board for Educator Certification. I declare the following:
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 a 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. I declare under penalty of perjury that the foregoing is true and correct. 
Name (First, Middle, Last)*
Date of Birth*
Address (Street, City, State, Zip Code*
County*
Executed in* County
State of*
this date* Date Month Year
Signature of Declarant* By entering your name (first, middle, and last) below, you are declaring: 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 this unsworn declaration.* *This form will be processed separately and not shared with the hiring manager. Approved by the Texas Commissioner of Education, October 2017.
Submission* In order that the officials of the Smyer Independent School District may be fully informed as to my personal character and qualifications for employment, I authorize my references to be contacted and speak freely regarding my qualifications. In that regard, I hold them harmless from any civil actions on my part regarding comments. I hereby authorize the party receiving this form to give full and complete information as may be requested by the Smyer Independent School District. I agree that the information requested will be come a part of my personnel file if I am employed by the District. I further agree that their information will not be disclosed to me, but will be treated as confidential by the District. I waive any right to see this information at anytime, either prior to, during or subsequent to my employment. I hereby authorize the Smyer Independent School District to request from my previous employers or any other persons who may have knowledge of me, information relative to my prior employment and to my personal character and qualifications for employment and I hereby authorize my previous employers and others to release the same.

Our Mission
The mission of the Smyer Independent School District is to provide a diversified system characterized by quality, equity, character, and accountability. All students will acquire the knowledge and skills necessary to be productive members of a global world.

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