PTAA Faculty/Staff Application PTAA Faculty/Staff Application First Name Middle Name Last Name Gender select ...MaleFemale Suffix (circle appropriate) Mr.MsMrs.Dr Marital status select ...SingleMarriedDivorcedSeprated Address City State Zip Code International address (if applicable) Address City Country Zip code Mobile Email Best way to contact you How did you hear about PTAA Which campus are you applying to (please check) MesquiteGreenville What role are you interested in (please check) InstructionalLeadership/Support Staff Answer questions as completely as space will permit. Avoid reference to race, religion, politics, or memberships in fraternal orders. Misstatements of material facts or omission are cause for disqualifications of candidacy or dismissal from employment. PLEASE ANSWER EACH OF THE FOLLOWING QUESTIONS: Are you a U.S Citizen? YesNo If you are not a U.S. Citizen, do you have the legal right to work in the U.S? YesNo 2. List any language you read, speak, or write fluently (in addition to English.) (Answering this question is optional unless foreign language capability is required by the job description of the position for which you are applying. Language Read Write Speak Action read Write speak -+ 3. Describe your academic, vocational, or professional education related to the position for which you are applying: Educational Background School Attended Degree Major Year Action -+ 4. List any military training or experience which you believe has a bearing on your qualifications for this position. 5. Certificates and/or licenses which may apply to this position. (Attach current certificates as required.) 6. List any computer, software, machine, and/or equipment you can operate which may have a bearing on your qualifications for this position. Typing: wpm Shorthand: wpm 7. Membership in professional organizations: (You may omit those organizations that indicate your race, religion creed, disability, marital status, national origin, ancestry, sex, or age.) 8. List any volunteer or community experience that would be of value to you in this position. 9. Were you ever discharged or forced to resign from any position? YesNo 10. Give the name, addresses, and phone numbers of two persons (not employers) who have knowledge of your character work experience, and ability. Do not give names of relatives. Name Address Phone Relationship Experience: List PRESENT job FIRST, then other jobs in order, working down from the most recent. NOTE: A resume and/or additional pages may be attached, but the application must be completed. Explain gaps between periods of employment. Employment Dates month/yr Title Employer - Detail Reason for leaving Action From To -+ 12. Would you object to having any of the listed employers contacted in regard to your work? YesNo 13. Additional information or comments: 14. Have you ever been convicted of any crime since the age of 18? YesNo If yes, please list date and disposition of case: 15. Are you willing to have a physical examination, if required, after employment? YesNo 16. Are you willing to be fingerprinted, after employment, as required by law? YesNo If available, please include current resume. 17. CERTIFICATION OF APPLICANT. Read carefully before signing: I hereby certify that my answers to the questions in this application are complete, accurate, and true to the best of my knowledge. I agree and understand that any omissions or misstatements of material fact contained in the application may cause me to forfeit all rights to employment with PTAA. Signature of Applicant Date PTAA does not discriminate in admissions based on gender; national origin; ethnicity; religion; disability; academic, artistic, or athletic ability; or the district the child would otherwise attend.