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 retain his/her right to access to this □

The applicant has chosen to waive his/her right of access to this
reference. This reference may be read by the applicant upon request.
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 - _____________

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 5 4 3 2 1 N/A
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 5 4 3 2 1 N/A

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:_________________________________
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? □ Yes □ No □ Doubtful
Your relationship with the applicant: □ Employer □ Mentor Teacher □ 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 retain his/her right to access to this □

The applicant has chosen to waive his/her right of access to this
reference. This reference may be read by the applicant upon request.
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 - _____________

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 5 4 3 2 1 N/A
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 5 4 3 2 1 N/A

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:_________________________________
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? □ Yes □ No □ Doubtful
Your relationship with the applicant: □ Employer □ Mentor Teacher □ 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 retain his/her right to access to this □

The applicant has chosen to waive his/her right of access to this
reference. This reference may be read by the applicant upon request.
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 - _____________

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 5 4 3 2 1 N/A
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 5 4 3 2 1 N/A

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:_________________________________
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? □ Yes □ No □ Doubtful
Your relationship with the applicant: □ Employer □ Mentor Teacher □ 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 retain his/her right to access to this □

The applicant has chosen to waive his/her right of access to this
reference. This reference may be read by the applicant upon request.
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 - _____________

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 5 4 3 2 1 N/A
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 5 4 3 2 1 N/A

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:_________________________________
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? □ Yes □ No □ Doubtful
Your relationship with the applicant: □ Employer □ Mentor Teacher □ 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 retain his/her right to access to this □

The applicant has chosen to waive his/her right of access to this
reference. This reference may be read by the applicant upon request.
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 - _____________

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 5 4 3 2 1 N/A
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 5 4 3 2 1 N/A

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:_________________________________
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? □ Yes □ No □ Doubtful
Your relationship with the applicant: □ Employer □ Mentor Teacher □ 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: □ Male □ Female

Ethnicity: □ 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.