Job Application -- Communities In Schools of North Texas, Inc.

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Job Application

Note: Fields with an * are required for form processing. Please use the TAB key or click in the respective form boxes to navigate the fields. Do not hit ENTER until you have completely finished filling out the application. Pressing the enter key automatically submits the application.

Personal Information

Last 4 digits of Social Security Number*	Last Name*	First Name*	Middle Initial

Street Address*	City*	State *	Zip*

Home Phone*	Business Phone	E-mail Address*

Bilingual? Yes No
If yes, please list language(s)

Position Applying For

Position Title*

Position Location (Please check all areas of interest)*

Lewisville ISD

Denton ISD

Northwest ISD

Little Elm ISD

Record of Education

School	Graduation Year	Completed Diploma, Degree, or Certificate	Major/Minor
High School/GED* City* State*		Diploma Certificate Degree None
College/University 1* City* State*		Diploma Certificate Degree None
College/University 2 City State		Diploma Certificate Degree None
Graduate School City State		Diploma Certificate Degree None
Other City State		Diploma Certificate Degree None

Skills Inventory*

Please list any skills you may have which relate to the position for which you are applying:

Employment History

Are you now or have you ever been employed by CIS?*	When, where, and in what position?
No Yes

Start with your present or most recent work experience and work back through previous positions. This section must be completed even if enclosing a resume and also, all periods of employment or unemployment should be covered.

Work Experience 1

Date Started (mm-dd-yy)	Date Left	Name of Company

Address-Street	City	State	Zip

Area Code and Phone	Supervisor	Supervisor's position

Beginning Yearly Salary	Ending Yearly Salary	Job Title

Duties

Reason for Leaving

Work Experience 2

Date Started (mm-dd-yy)	Date Left	Name of Company

Address-Street	City	State	Zip

Area Code and Phone	Supervisor	Supervisor's position

Beginning Yearly Salary	Ending Yearly Salary	Job Title

Duties

Reason for Leaving

Work Experience 3

Date Started (mm-dd-yy)	Date Left	Name of Company

Address-Street	City	State	Zip

Area Code and Phone	Supervisor	Supervisor's position

Beginning Yearly Salary	Ending Yearly Salary	Job Title

Duties

Reason for Leaving

Work Experience 4

Date Started (mm-dd-yy)	Date Left	Name of Company

Address-Street	City	State	Zip

Area Code and Phone	Supervisor	Supervisor's position

Beginning Yearly Salary	Ending Yearly Salary	Job Title

Duties

Reason for Leaving

Work Experience 5

Date Started (mm-dd-yy)	Date Left	Name of Company

Address-Street	City	State	Zip

Area Code and Phone	Supervisor	Supervisor's position

Beginning Yearly Salary	Ending Yearly Salary	Job Title

Duties

Reason for Leaving

Names under which you are known to employers or schools attended, if different from your current name:

May we contact the employers listed?*
Yes No

If no, please indicate the ones you do not wish us to contact.

Have you ever been convicted for a violation of any law other than minor traffic violations?*
Yes No

If yes, give year, locations, and nature of violatoin and disposition. (A conviction will be considered only if relevant to a particular position.)

All Applicants must read and sign the following statement

1. I certify that statements made by me in this application are true, complete, and correct to the best of my knowledge and belief. I understand that any false statements or omissions made by me in connection with my application may be grounds for rejection of my application or dismissal after employment.
2. I hereby authorize Communities In Schools to investigate, through whatever means deemed appropriate, any information included in this application and all facts resulting from the investigation unless otherwise noted. CIS is also authorized to use any information obtained from its investigations to determine my suitability for employment. I release CIS from any liability in connection with such investigation.
3. If employed, I agree to abide by the policies, procedures, rules and regulations of CISNT. I acknowledge the CIS's prerogative of revising, at any time, its policies, procedures, rules and regulations and I agree to abide and be governed by such revisions.
4. I understand that there is a probationary period for all employees.
5. I further understand that each employee is without a written contract of employment, is employed on an at-will basis and employment may be terminated by either the employee or CIS, with or without cause.
6. I understand that submission of this application does not obligate CIS in any way.
7. I hereby authorize any former employers or any other persons given as references (unless otherwise noted) to answer any questions that may be asked.
8. The Immigration Reform and Control Act of 1986 requires all applicants to provide proof of identity and eligibility to work in the United States prior to any offer of employment being made.
9. CIS prohibits the unlawful possession, use, or distribution of illicit drugs and alcohol by employees on its property or as part of any of its activities. No employee is permitted to use or possess alcohol in any CIS office. Any employee who violates these standards of conduct for illicit drugs or the unlawful possession or use of alcohol is subject to termination.
10. This application will be considered if it is completed, signed and dated below.

Signature of Applicant*

Date (mm-dd-yy)*

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