The Holland Independent School District is authorized by state law to obtain criminal history record information on applicants the district intends to employ (Texas Education Code §22.083). The information requested below is required to obtain a criminal history record.
Name_________________________________________________________
Last First Middle
Maiden
Social
Security number__________________ Date of birth ____________
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 personnel
office.