Breckenridge 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. Please print. Name _____________________________________________________ (Last, Middle Initial) Social Security Number Date of birth _____________________ Driver’s License ________________________________________________ (State and Number) Mailing Address _____________________________________________ (Street, City, State, Zip) _________________________________________________________________________ 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 for the purpose of obtaining criminal solely history record information.* Signature Date ______________________________
Breckenridge 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. Please print. Name (Last, Middle Initial) _____________________________________________________ Social Security Number Date of birth _____________________ Driver’s License (State and Number) ________________________________________________ Mailing Address (Street, City, State, Zip) _____________________________________________ _________________________________________________________________________ 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 ______________________________
BISDApplicationforSupportPersonnelPRINTABLE.docx