Escolar Documentos
Profissional Documentos
Cultura Documentos
PERSONAL INFORMATION
Name (Last, First, MI): For correspondence purposes only, please check one of the salutations: Mr. Ms. Dr.
Residence Address: (Please list if different from above.) City: State: Zip:
E-mail Address:
May we contact you at work? Yes No
ACADEMIC ACCREDITATION
Dates of Attendance Total Sem.
Name of Institution Fr: Mo/Yr To: Mo/Yr Type & Date Units
(Beyond High School) City, State Major Minor Degree Granted Completed
REFERENCES – Name of persons who are familiar with your previous employment experience whom we may contact if you are a finalist.
Name Title Business/Institution Daytime Phone Number
LIST (MOST RECENT FIRST) ALL ACADEMIC EXPERIENCE OTHER THAN TEACHING (i.e., COUNSELING OR ADMIN) (Use an additional sheet, if necessary)
Employment Dates Mailing Address Time
From To Name of Institution or District Including Zip Code Title of Position Full % Reason for Leaving
OTHER PROFESSIONAL ACTIVITIES (Such as travel, publications, organizations, lectures) (Use an additional sheet, if necessary)
You may omit those organizations that indicate your race, religious creed, color, disability, marital status, national origin, ancestry, sex, sexual orientation or age.
Length of Service Nature of Experience
Current Employer
If you are currently employed, may we contact your present employer? Yes No
If “NO”, please be advised that we must contact your employer should you become a finalist for the position.
GENERAL: (This space is provided for any additional information which you believe will be helpful in considering your application.)
I declare that the information in this application is true and complete to the best of my knowledge, and I authorize investigation of all statements herein recorded. I
waive and release from all liability persons and organizations reporting information required by this application. I certify that I do not advocate, nor am I a member of
any party or organization, political or otherwise, that now advocates the overthrow of the government of the United States or the State of California by force or
violence or other unlawful means. I understand that I will be subject to forfeiture of the employment process or dismissal if any statement in this application is found to
be untrue.
CONFIDENTIAL
THIS SUPPLEMENTAL INFORMATION IS FOR THE USE OF THE HUMAN RESOURCES OFFICE ONLY
Please Print
Have you ever been employed, attended college, or obtained a job related degree or certificate under another name? Yes No
If “YES”, please state name, where and when. ________________________________________________________________________
Have you ever been convicted or pled nolo contender for a criminal offense (excluding traffic violations)? Yes No
If you checked “YES”, please state the nature of the crime(s), when and where convicted and disposition of the case, even if the case was
dismissed or expunged. Exceptions are court actions resulting in the sealing of a juvenile record. Convictions will be reviewed for job
relatedness, but will not necessarily exclude you from employment with the District.
Nature of Crime Date Where Convicted Disposition (outcome)