SCHOOL DISTRICT OF HILLSBOROUGH COUNTY APPLICATION CENTER 1202 EAST PALM AVENUE TAMPA, FLORIDA

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1 SCHOOL DISTRICT OF HILLSBOROUGH COUNTY APPLICATION CENTER 1202 EAST PALM AVENUE TAMPA, FLORIDA APPLICATION FOR EMPLOYMENT : (Last) (First) (Middle) AN EQUAL OPPORTUNITY EMPLOYER School Board Policy 6.01 ensures equal opportunity for all in its personnel policies and practices and does not discriminate on the basis of race, color, sex, religion, national origin, marital status, disability or age. APPLICATIONS MUST BE COMPLETE AND RENEWED YEARLY Transcripts are required as applicable. This application will be considered only if it has been completed fully and accurately. Offers of employment are subject to proper qualifications and/or certification. School District of Hillsborough County workplaces are drug-free. Employees are prohibited from engaging in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance. Violation of this prohibition shall result in appropriate disciplinary action up to and including termination. NOTE: CURRENT AND/OR FORMER EMPLOYEES - DO NOT COMPLETE THIS APPLICATION. INSTEAD, COMPLETE THE APPLICATION UPDATE FORM. I AM APPLYING FOR THE FOLLOWING POSITION(S): EXECUTIVE, ADMINISTRATIVE, MANAGEMENT - All the positions in this job family require at least a Master's Degree from an accredited college or university or equivalent responsible related experience. Superintendent Operations/Program Area Administrator/Manager Organizational Area Senior Executive Principal, Assistant Principal or Site Administrator INSTRUCTIONAL PROFESSIONAL - All the positions in this family require at least a Bachelor's Degree from an accredited college or university. (* Bachelor s or Associate s Degree and/or equivalent related experience) Classroom Teacher School Psychologist Media Specialist Resource Teacher Guidance Counselor Professional Trainer Guidance Resource Teacher Speech Therapist School Social Worker Educational Career Specialist * TECHNICAL PROFESSIONAL - All the positions in this job family require at least a High School Diploma/GED Equivalent. Some require additional certification and/or degrees. Nursing Personnel Fiscal, Budget, Purchasing, Risk Analysts Audiologist Investigator, Security, Safety Specialist Programmer, Network Analyst Engineer, Architect, Inspector Administrative, Executive Assistants Benefits, Personnel Specialist Auditor, Accountant Occupational, Physical Therapist CLERICAL SUPPORT - All the positions in this job family require at least a High School Diploma/GED Equivalent. Some require additional certification and/or degrees. Clerk Customer Service Representative Secretary Receptionist Bookkeeper Registrar Data Processor Office Network Computer Specialist I AM APPLYING FOR THE FOLLOWING POSITION(S): INSTRUCTIONAL SUPPORT - All the positions in this job family require at least a High School Diploma/GED Equivalent. Some require additional certification and/or degrees. Substitute Teacher Assistant Teacher, Instructor Classroom Paraprofessional Child Care Worker Student Services Paraprofessional Speech Assistant OPERATIONS SUPPORT - All the positions in this job family require at least completion of 6th grade education or higher. Some require additional certification and/or degrees. Student Nutrition Services Telephone # SS # PERMANENT ADDRESS: Automotive/Equipment Repair & Maintenance Bus Driver Custodial, Maintenance, Grounds Purchasing and Warehouse Skilled and Unskilled Labor Street/Apt. City/State/Zip TEMPORARY ADDRESS: Street/Apt. City/State/Zip Are you a citizen of the United States of America?, but I have a current, valid employment work authorization., but I have a previous H-1B-Visa that I need to refile., I need sponsorship. I do not have employment work authorization.

2 PERSONAL: Are you a veteran of the U.S. Military? (Complete the Attached Veterans' Preference Form if Applicable.) Are you in the National Guard or the U.S. Armed Forces Reserves? National Guard Reserves Neither Have you ever been an employee of the School District of Hillsborough County in any job? If yes, under what name were you employed? Must your records be withheld from release in accordance with the Public Records Law? We ask for. your ethnicity so we may judge our hiring practices and Equal Employment Opportunity compliance. It WILL NOT be used in making employment decisions, except as allowed by law. American Indian/Alaskan Native Multi Racial Asian Pacific Islander ne Selected Black, n Hispanic ne of the Above Hispanic White, n-hispanic CERTIFICATION/LICENSURE: 1. If you have an Educator Certificate or Professional/Technical License, please provide the following information: (Please note: Statement of Eligibility is not a teaching certificate.) List Certification/License Coverage(s) on your certificate/license: State Issuing Certificate/License: Validity Dates: _ to Type of Certificate/License: Temporary Professional Other Certificate/License Number: 2. Has action ever been taken against your certificate by any Education Practices Commission? If yes, attach a copy of any Final Order(s) that was (were) issued. 3. Have you ever had any professional license (a driver's license is not a professional license) or professional certificate, including a teaching certificate, sanctioned by the issuing agency in this or any state? Sanctioned is defined to include suspension, revocation; discipline, such as issuance of a reprimand or fine; or, otherwise conditioned, such as placed on any restriction or probation. 4. Have you ever resigned, surrendered, or otherwise relinquished a professional license or certificate in this or any state? 5. Is there any action pending in this or any state against a professional license or certificate you hold or held? 6. Is there any action pending in this or any state against an application for a professional license or certificate you have on file? (A determination of academic ineligibility is not considered denial of a license or certificate.) IF YOU ANSWERED YES TO ANY OF THE QUESTIONS 3 THROUGH 6, PLEASE EXPLAIN THE CIRCUMSTANCES ON THE ATTACHED/DOWNLOADED CERTIFICATE/LICENSE ACTION FORM AND SEND FORM TO THE APPLICATION CENTER.

3 CRIMINAL HISTORY: ATTENTION: PLEASE READ VERY CAREFULLY. Under provisions in Florida Statutes and , the entire arrest record is revealed to school districts by the Florida Department of Law Enforcement and the FBI when fingerprints are supplied, including "sealed records" and "expunged records." Therefore, you are required to reveal such information on the criminal history form. Be aware that falsification of records includes omission of information and constitutes grounds for dismissal. Conviction of a crime will not necessarily be a bar to employment. Factors such as age at the time of the offense, type of offense, remoteness of the offense in time and rehabilitation will be taken into account in determining effect on suitability for employment. Check either or next to each question. Have you ever been arrested or charged for a criminal offense other than a minor traffic violation? NOTE: DUI s are NOT minor traffic violations. Is there any criminal charge now pending against you other than a minor traffic violation? NOTE: DUI s are NOT minor traffic violations. Are you currently on probation or currently under any imposed requirements for charges other than a minor traffic violation? NOTE: DUI s are NOT minor traffic violations. If YES to any of the above, download the CRIMINAL RECORD INFORMATION form, complete it, and send it with this application to the Application Center. EDUCATIONAL PREPARATION: Circle the Highest Grade Completed General Education College Graduate School of School Attended School Level High School or Last School Attended Diploma or Degree Type Graduated or Date Received Degree or Date Anticipated If Applicable, Answer Questions Below If you did not graduate, do you have a GED certificate? If yes, date issued:

4 WORK EXPERIENCE AND/OR TEACHING EXPERIENCE: (List Present/Recent Position First) (LIST INTERNSHIP/STUDENT TEACHING; DO NOT LIST PRACTICUM) of Business/School and Supervisor Phone From () To () Your Title REFERENCES: List two professional references, including principals (current and/or last) and supervisors. Please provide correct addresses which are legible and complete. Employment Outside of Education: Provide the name of at least one immediate supervisor. Applicants who have never been employed should provide two personal references. IF YOU ARE A TEACHER APPLICANT: Experienced Teacher: Provide the name of your most recent principal or immediate supervisor. Recent Graduate: Provide names of both the directing teacher and the principal of the internship school. Reference s and Position of School/Business and Zip Area Code and Telephone Number Position Position

5 y S School District of Hillsborough County Mail to: Providence C. Velasco Student Services Center ATTN: APPLICATION CENTER 1202 East Palm Avenue Tampa, Florida I,, certify that the answers and statements I have provided to the questions on the employment application are true and correct without any falsifications, omissions, or misleading statements of any kind whatsoever. I agree that the District School Board of Hillsborough County shall not be held liable in any respect if I am not employed or if my employment is terminated because of false or misleading statements or answers or omissions made by me in this application. Signature of Applicant: Printed : Social Security Number: _ Date Signed: Please remember to attach any other required documents. If at any time you wish to view your application, please visit our website and login to the application section using your User and Password. (If you did not apply online, you may still login but first you will need to retrieve your assigned User and Password. To do so, go to the Human Resources website (http://apps.sdhc.k12.fl.us/hrdiv/), click on APPLICATION FOR EMPLOYMENT (on the left side of the Human Resources home page) * find the area in the center of the page that says: DO YOU NEED YOUR USER NAME AND PASSWORD? and follow the directions below it to retrieve your USER NAME and PASSWORD * Return to the Login page to login to the Application for Employment. Once logged-in, you may see your current application status, and links to any documents you may need to complete and send to Application Center.) YOUR APPLICATION MUST BE SUBMITTED WITH ALL REQUIRED DOCUMENTS. After signing and dating this signature form, please make a copy for your records and mail the original to the address at the top of this signature form. AN EQUAL OPPORTUNITY EMPLOYER School Board Policy 6.01 ensures equal opportunity for all in its personnel policies and practices and does not discriminate on the basis of race, color, sex, religion, national origin, marital status, disability, or age. Raymond O. Shelton School Administrative Center 901 East Kennedy Boulevard Tampa, Florida Office: Phone: SUNCOM School District Information Fax: P.O. Box 3408 Tampa, FL Web Site:

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