HARLINGEN CONSOLIDATED INDEPENDENT SCHOOL DISTRICT HUMAN RESOURCES DEPARTMENT

407 N. 77 Sunshine Strip, Harlingen, Texas 78550 (956) 430-9500 1-888-747-4401 Fax: (956) 430-9515

Name of Reference:________________________________

Title of Reference:__________________________________

You have been named as one who is acquainted with the qualifications, character, and ability of the applicant named below. The applicant has on file in his/her application, a statement reflecting how the school district may treat references received. The appropriate statement below is checked for your information. The applicant has chosen to waive his/her right of access to this reference. Therefore, this reference may not be read by the applicant. TO BE COMPLETED BY THE APPLICANT. FORWARD THE FORM TO A CURRENT / FORMER SUPERVISOR, OR AN INDIVIDUAL THAT IS FAMILIAR WITH YOUR QUALIFICATIONS, CHARACTER, AND ABILITY. Applicant's Name:_________________________________________ Applicant's Social Security # (Last 4 digits): XXX - XX - _____________ The applicant has chosen to retain his/her right to access to this reference. This reference may be read by the applicant upon request.

Position(s) applying for:____________________________________________________________________________________________________ AUTHORIZATION I authorize the above named reference to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the above named reference from liability for any damage that may result from furnishing same to you. Applicant signature:________________________________________ Date:___________________________________________________ TO BE COMPLETED BY THE REFERENCE NAMED ABOVE. RATE THE APPLICANT BY CHECKING THE APPROPRIATE BOX BELOW. (EXCELLENT 5 4 3 2 1 NEEDS IMPROVEMENT) IF YOU HAVE NOT HAD AN OPPORTUNITY TO OBSERVE, INDICATE N/A. WORK RELATED CHARACTERISTICS General appearance, dress, and grooming Communicates effectively Gets along well with others Accepts constructive criticism Maintains good attendance Is punctual Demonstrates good judgement Demonstrates extensive knowledge in field Stays current with trends and issues in field Works well as a member of a team Is receptive to new ideas and changes TO BE COMPLETED BY THE REFERENCE NAMED ABOVE. RATE THE APPLICANT BY CHECKING THE APPROPRIATE BOX BELOW. TEACHING CHARACTERISTICS Provides an effective learning environment Uses a variety of effective teaching methods Sensitive to differences and needs of others Uses effective strategies for class management Communicates well with parents Uses effective assessment strategies Between what dates do you know the work of the applicant? From:_________________________ To:_________________________________ 5 4 3 2 1 N/A 5 4 3 2 1 N/A

What position did the applicant then occupy?___________________________________________________________________________________ Has the applicant ever failed to be re-employed?________________________________________________________________________________ If you were an employer, would you hire this person? Your relationship with the applicant:

□ Employer □ Mentor Teacher

□ Yes

□ No □ Doubtful □ College Supervisor □ Supervisor □ Other______________

Reference Signature:_________________________________ Official Title:___________________________ Date:__________________________ Reference Phone numbers: Home ________________________ Work ________________________ Cell _____________________________

THANK YOU. YOU MAY USE THE BACK OF THE FORM FOR ADDITIONAL COMMENTS. PLEASE MAIL THE COMPLETED REFERENCE TO THE HUMAN RESOURCES DEPARTMENT AT THE ADDRESS LISTED ABOVE.

HARLINGEN CONSOLIDATED INDEPENDENT SCHOOL DISTRICT HUMAN RESOURCES DEPARTMENT
407 N. 77 Sunshine Strip, Harlingen, Texas 78550 (956) 430-9500 1-888-747-4401 Fax: (956) 430-9515

Name of Reference:________________________________

Title of Reference:__________________________________

You have been named as one who is acquainted with the qualifications, character, and ability of the applicant named below. The applicant has on file in his/her application, a statement reflecting how the school district may treat references received. The appropriate statement below is checked for your information. The applicant has chosen to waive his/her right of access to this reference. Therefore, this reference may not be read by the applicant. TO BE COMPLETED BY THE APPLICANT. FORWARD THE FORM TO A CURRENT / FORMER SUPERVISOR, OR AN INDIVIDUAL THAT IS FAMILIAR WITH YOUR QUALIFICATIONS, CHARACTER, AND ABILITY. Applicant's Name:_________________________________________ Applicant's Social Security # (Last 4 digits): XXX - XX - _____________ The applicant has chosen to retain his/her right to access to this reference. This reference may be read by the applicant upon request.

Position(s) applying for:____________________________________________________________________________________________________ AUTHORIZATION I authorize the above named reference to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the above named reference from liability for any damage that may result from furnishing same to you. Applicant signature:________________________________________ Date:___________________________________________________ TO BE COMPLETED BY THE REFERENCE NAMED ABOVE. RATE THE APPLICANT BY CHECKING THE APPROPRIATE BOX BELOW. (EXCELLENT 5 4 3 2 1 NEEDS IMPROVEMENT) IF YOU HAVE NOT HAD AN OPPORTUNITY TO OBSERVE, INDICATE N/A. WORK RELATED CHARACTERISTICS General appearance, dress, and grooming Communicates effectively Gets along well with others Accepts constructive criticism Maintains good attendance Is punctual Demonstrates good judgement Demonstrates extensive knowledge in field Stays current with trends and issues in field Works well as a member of a team Is receptive to new ideas and changes TO BE COMPLETED BY THE REFERENCE NAMED ABOVE. RATE THE APPLICANT BY CHECKING THE APPROPRIATE BOX BELOW. TEACHING CHARACTERISTICS Provides an effective learning environment Uses a variety of effective teaching methods Sensitive to differences and needs of others Uses effective strategies for class management Communicates well with parents Uses effective assessment strategies Between what dates do you know the work of the applicant? From:_________________________ To:_________________________________ 5 4 3 2 1 N/A 5 4 3 2 1 N/A

What position did the applicant then occupy?___________________________________________________________________________________ Has the applicant ever failed to be re-employed?________________________________________________________________________________ If you were an employer, would you hire this person? Your relationship with the applicant:

□ Employer □ Mentor Teacher

□ Yes

□ No □ Doubtful □ College Supervisor □ Supervisor □ Other______________

Reference Signature:_________________________________ Official Title:___________________________ Date:__________________________ Reference Phone numbers: Home ________________________ Work ________________________ Cell _____________________________

THANK YOU. YOU MAY USE THE BACK OF THE FORM FOR ADDITIONAL COMMENTS. PLEASE MAIL THE COMPLETED REFERENCE TO THE HUMAN RESOURCES DEPARTMENT AT THE ADDRESS LISTED ABOVE.

HARLINGEN CONSOLIDATED INDEPENDENT SCHOOL DISTRICT HUMAN RESOURCES DEPARTMENT
407 N. 77 Sunshine Strip, Harlingen, Texas 78550 (956) 430-9500 1-888-747-4401 Fax: (956) 430-9515

Name of Reference:________________________________

Title of Reference:__________________________________

You have been named as one who is acquainted with the qualifications, character, and ability of the applicant named below. The applicant has on file in his/her application, a statement reflecting how the school district may treat references received. The appropriate statement below is checked for your information. The applicant has chosen to waive his/her right of access to this reference. Therefore, this reference may not be read by the applicant. TO BE COMPLETED BY THE APPLICANT. FORWARD THE FORM TO A CURRENT / FORMER SUPERVISOR, OR AN INDIVIDUAL THAT IS FAMILIAR WITH YOUR QUALIFICATIONS, CHARACTER, AND ABILITY. Applicant's Name:_________________________________________ Applicant's Social Security # (Last 4 digits): XXX - XX - _____________ The applicant has chosen to retain his/her right to access to this reference. This reference may be read by the applicant upon request.

Position(s) applying for:____________________________________________________________________________________________________ AUTHORIZATION I authorize the above named reference to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the above named reference from liability for any damage that may result from furnishing same to you. Applicant signature:________________________________________ Date:___________________________________________________ TO BE COMPLETED BY THE REFERENCE NAMED ABOVE. RATE THE APPLICANT BY CHECKING THE APPROPRIATE BOX BELOW. (EXCELLENT 5 4 3 2 1 NEEDS IMPROVEMENT) IF YOU HAVE NOT HAD AN OPPORTUNITY TO OBSERVE, INDICATE N/A. WORK RELATED CHARACTERISTICS General appearance, dress, and grooming Communicates effectively Gets along well with others Accepts constructive criticism Maintains good attendance Is punctual Demonstrates good judgement Demonstrates extensive knowledge in field Stays current with trends and issues in field Works well as a member of a team Is receptive to new ideas and changes TO BE COMPLETED BY THE REFERENCE NAMED ABOVE. RATE THE APPLICANT BY CHECKING THE APPROPRIATE BOX BELOW. TEACHING CHARACTERISTICS Provides an effective learning environment Uses a variety of effective teaching methods Sensitive to differences and needs of others Uses effective strategies for class management Communicates well with parents Uses effective assessment strategies Between what dates do you know the work of the applicant? From:_________________________ To:_________________________________ 5 4 3 2 1 N/A 5 4 3 2 1 N/A

What position did the applicant then occupy?___________________________________________________________________________________ Has the applicant ever failed to be re-employed?________________________________________________________________________________ If you were an employer, would you hire this person? Your relationship with the applicant:

□ Employer □ Mentor Teacher

□ Yes

□ No □ Doubtful □ College Supervisor □ Supervisor □ Other______________

Reference Signature:_________________________________ Official Title:___________________________ Date:__________________________ Reference Phone numbers: Home ________________________ Work ________________________ Cell _____________________________

THANK YOU. YOU MAY USE THE BACK OF THE FORM FOR ADDITIONAL COMMENTS. PLEASE MAIL THE COMPLETED REFERENCE TO THE HUMAN RESOURCES DEPARTMENT AT THE ADDRESS LISTED ABOVE.

HARLINGEN CONSOLIDATED INDEPENDENT SCHOOL DISTRICT HUMAN RESOURCES DEPARTMENT
407 N. 77 Sunshine Strip, Harlingen, Texas 78550 (956) 430-9500 1-888-747-4401 Fax: (956) 430-9515

Name of Reference:________________________________

Title of Reference:__________________________________

You have been named as one who is acquainted with the qualifications, character, and ability of the applicant named below. The applicant has on file in his/her application, a statement reflecting how the school district may treat references received. The appropriate statement below is checked for your information. The applicant has chosen to waive his/her right of access to this reference. Therefore, this reference may not be read by the applicant. TO BE COMPLETED BY THE APPLICANT. FORWARD THE FORM TO A CURRENT / FORMER SUPERVISOR, OR AN INDIVIDUAL THAT IS FAMILIAR WITH YOUR QUALIFICATIONS, CHARACTER, AND ABILITY. Applicant's Name:_________________________________________ Applicant's Social Security # (Last 4 digits): XXX - XX - _____________ The applicant has chosen to retain his/her right to access to this reference. This reference may be read by the applicant upon request.

Position(s) applying for:____________________________________________________________________________________________________ AUTHORIZATION I authorize the above named reference to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the above named reference from liability for any damage that may result from furnishing same to you. Applicant signature:________________________________________ Date:___________________________________________________ TO BE COMPLETED BY THE REFERENCE NAMED ABOVE. RATE THE APPLICANT BY CHECKING THE APPROPRIATE BOX BELOW. (EXCELLENT 5 4 3 2 1 NEEDS IMPROVEMENT) IF YOU HAVE NOT HAD AN OPPORTUNITY TO OBSERVE, INDICATE N/A. WORK RELATED CHARACTERISTICS General appearance, dress, and grooming Communicates effectively Gets along well with others Accepts constructive criticism Maintains good attendance Is punctual Demonstrates good judgement Demonstrates extensive knowledge in field Stays current with trends and issues in field Works well as a member of a team Is receptive to new ideas and changes TO BE COMPLETED BY THE REFERENCE NAMED ABOVE. RATE THE APPLICANT BY CHECKING THE APPROPRIATE BOX BELOW. TEACHING CHARACTERISTICS Provides an effective learning environment Uses a variety of effective teaching methods Sensitive to differences and needs of others Uses effective strategies for class management Communicates well with parents Uses effective assessment strategies Between what dates do you know the work of the applicant? From:_________________________ To:_________________________________ 5 4 3 2 1 N/A 5 4 3 2 1 N/A

What position did the applicant then occupy?___________________________________________________________________________________ Has the applicant ever failed to be re-employed?________________________________________________________________________________ If you were an employer, would you hire this person? Your relationship with the applicant:

□ Employer □ Mentor Teacher

□ Yes

□ No □ Doubtful □ College Supervisor □ Supervisor □ Other______________

Reference Signature:_________________________________ Official Title:___________________________ Date:__________________________ Reference Phone numbers: Home ________________________ Work ________________________ Cell _____________________________

THANK YOU. YOU MAY USE THE BACK OF THE FORM FOR ADDITIONAL COMMENTS. PLEASE MAIL THE COMPLETED REFERENCE TO THE HUMAN RESOURCES DEPARTMENT AT THE ADDRESS LISTED ABOVE.

HARLINGEN CONSOLIDATED INDEPENDENT SCHOOL DISTRICT HUMAN RESOURCES DEPARTMENT
407 N. 77 Sunshine Strip, Harlingen, Texas 78550 (956) 430-9500 1-888-747-4401 Fax: (956) 430-9515

Name of Reference:________________________________

Title of Reference:__________________________________

You have been named as one who is acquainted with the qualifications, character, and ability of the applicant named below. The applicant has on file in his/her application, a statement reflecting how the school district may treat references received. The appropriate statement below is checked for your information. The applicant has chosen to waive his/her right of access to this reference. Therefore, this reference may not be read by the applicant. TO BE COMPLETED BY THE APPLICANT. FORWARD THE FORM TO A CURRENT / FORMER SUPERVISOR, OR AN INDIVIDUAL THAT IS FAMILIAR WITH YOUR QUALIFICATIONS, CHARACTER, AND ABILITY. Applicant's Name:_________________________________________ Applicant's Social Security # (Last 4 digits): XXX - XX - _____________ The applicant has chosen to retain his/her right to access to this reference. This reference may be read by the applicant upon request.

Position(s) applying for:____________________________________________________________________________________________________ AUTHORIZATION I authorize the above named reference to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the above named reference from liability for any damage that may result from furnishing same to you. Applicant signature:________________________________________ Date:___________________________________________________ TO BE COMPLETED BY THE REFERENCE NAMED ABOVE. RATE THE APPLICANT BY CHECKING THE APPROPRIATE BOX BELOW. (EXCELLENT 5 4 3 2 1 NEEDS IMPROVEMENT) IF YOU HAVE NOT HAD AN OPPORTUNITY TO OBSERVE, INDICATE N/A. WORK RELATED CHARACTERISTICS General appearance, dress, and grooming Communicates effectively Gets along well with others Accepts constructive criticism Maintains good attendance Is punctual Demonstrates good judgement Demonstrates extensive knowledge in field Stays current with trends and issues in field Works well as a member of a team Is receptive to new ideas and changes TO BE COMPLETED BY THE REFERENCE NAMED ABOVE. RATE THE APPLICANT BY CHECKING THE APPROPRIATE BOX BELOW. TEACHING CHARACTERISTICS Provides an effective learning environment Uses a variety of effective teaching methods Sensitive to differences and needs of others Uses effective strategies for class management Communicates well with parents Uses effective assessment strategies Between what dates do you know the work of the applicant? From:_________________________ To:_________________________________ 5 4 3 2 1 N/A 5 4 3 2 1 N/A

What position did the applicant then occupy?___________________________________________________________________________________ Has the applicant ever failed to be re-employed?________________________________________________________________________________ If you were an employer, would you hire this person? Your relationship with the applicant:

□ Employer □ Mentor Teacher

□ Yes

□ No □ Doubtful □ College Supervisor □ Supervisor □ Other______________

Reference Signature:_________________________________ Official Title:___________________________ Date:__________________________ Reference Phone numbers: Home ________________________ Work ________________________ Cell _____________________________

THANK YOU. YOU MAY USE THE BACK OF THE FORM FOR ADDITIONAL COMMENTS. PLEASE MAIL THE COMPLETED REFERENCE TO THE HUMAN RESOURCES DEPARTMENT AT THE ADDRESS LISTED ABOVE.

HARLINGEN CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
CRIMINAL HISTORY RECORD INFORMATION REQUEST *CONFIDENTIAL
The Harlingen Consolidated Independent School District is required by Texas Education Code Chapter 22, Subchapter C, to review the criminal history of applicants, employees, independent contractors, student teachers, and certain volunteers. The information requested below is necessary to obtain criminal history record information. Full Name___________________________________________________________________ (Print) Last First Middle Social Security No.________________________ Date of Birth________________________ Driver’s License Number (DLN)__________________State DLN Issued_________________ Mailing Address______________________________________________________________ Street City State Zip Sex: Ethnicity:

□ Male

□ Female

□ White □ Black □ Hispanic □ Asian/Pacific □ American Indian/Alaskan □ Other___________________________
Specify

I understand that the information I am providing about age, sex, and ethnicity will not be used to determine eligibility for employment, but will be used solely for the purpose of obtaining criminal history record information. _________________________________ Signature __________________________ Date

*This form will be removed from the application and filed separately in the Human Resources office.

HARLINGEN CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
Harlingen CISD considers applicants for all positions without regard to race, color, national origin, age, religion, sex, marital status, veteran or military status, the presence of a medical condition, disability, or any other legally protected status.

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