WTSD - SS Licensed Practical Nurse (PRN) | Tennessee Schools for the Deaf

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Applicant Information

First Name*

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Middle Name

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Last Name*

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E-mail Address*

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Home Phone

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TSD Website

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Date Available to Start Work*

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Are you a citizen of the United States?*

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Yes

If not, are you authorized to work in the United States?

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Yes

Have you previously worked for the State of Tennessee?*

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Yes

If so, list department and dates employed.

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How would you rate your ASL skills?*

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Beginner

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Education

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High School / GED

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Did you graduate?

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Yes

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College

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Did you graduate?

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Yes

Degree

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Other Education

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References

Please list three professional references.

Reference 1

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Last Name*

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Company*

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Reference 2

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Company*

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Reference 3

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Last Name*

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E-mail*

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Phone Number*

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Relationship*

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Company*

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Employment History

Previous employers may be contacted during reference and background check procedures conducted by TSD.

Current Employer

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City

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Phone Number

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Supervisor

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Ending Salary

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Job Responsibilities

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Start Date

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End Date

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Reason For Leaving

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May we contact your supervisor for a reference?

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Yes

If not, what is your reasoning?

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Previous Employer 1

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City

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Phone Number

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Supervisor

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Starting Salary

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Ending Salary

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Job Responsibilities

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Start Date

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End Date

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Reason For Leaving

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Previous Employer 2

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City

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Zip/Postal

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Phone Number

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Supervisor

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Starting Salary

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Ending Salary

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Job Responsibilities

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Start Date

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End Date

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Reason For Leaving

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Licenses / Certifications

Please list each license, certificate, or other authorization to practice a trade or profession. Teachers must specify subject area and type of certification. Please make sure licensure information is current with each new application you submit.

License / Certificate 1

Type of Certification

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Area of Endorsement

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License / Certificate Number

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Original License Issue Date

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Current License Expiration Date

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Disclaimer and Signature

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If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

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WTSD - SS Licensed Practical Nurse (PRN)