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Teaching/Work Experience
Education History
Certification / References
Leadership Experience
Civic Activities
Professional Activities
Admission Reason
Support Documents
Checklist Signature
Pay Fee
Certification / References
Applicant Name:
Certificate Type
Valid Texas Certificate
YES
NO
Certificate Issue Date
(dd/mm/yyyy)
Certificate Exp. Date
(dd/mm/yyyy)
Texas
Emergency / Probationary
Certificate
YES
NO
Certificate Issue Date
(dd/mm/yyyy)
Certificate Exp. Date
(dd/mm/yyyy)
Revoked / Suspended
Certificate
YES
NO
Revoked / Suspended Reason
Administrative Position
YES
NO
Administrative Position Title
Administrative
Position District
Administrative
Position Campus
Please provide contact information for a minimum of three (3) professional references, excluding current supervisor.
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Name
Address
Bus Phone
Alt Phone
Email
Relation
Name
Address
Bus Phone
Alt Phone
Email
Relation
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I hereby voluntarily request that these recommendations be held strictly confidential, and I waive my right to review this recommendation at any time.