Lyon, Brandon

App Number: 20210079

Created: 4/23/2021 1:09:59 PM
Updated: 4/23/2021 1:20:55 PM

APPLICANT INFORMATION
Name: Brandon Gary Lyon
First Middle Last Other Name Used
Present Address
Address:

City/State/Zip:

Permanent Address (if different from above)

Address:

City/State/Zip:

Contact Information
Telephone (home): Best time to
call:
Telephone (work): Best time to
call:
Telephone Best time to
(mobile): call:
Email: [email protected] E-mail is used for all interview and
other District notices
Other:

PERSONAL INFORMATION
Have you reached your 18th Yes
Birthday?
Are you a U.S. Citizen? Yes
If not, are you eligible to work in the United
States?
If yes, what makes you
eligible?

Are you currently under contract with another school No

district?
If yes, which district? What position?

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Have you ever been granted tenure in the state of No
Michigan?
If yes, which district?

Date Available for

Employment:

What led you to apply to the Port Huron School District?

Own Initiative
If District Employee:
If Friend or Relative:
If Other:

Have you previously applied for employment with the Port Huron School No
District?
Date Positio
: n:

Have you previously worked for the Port Huron School District?
Date Positio
: n:

Please identify any of your relatives who are Port Huron School District Administrators:

What Professional or Community Organizations have you belonged to in the last 10 years?
Do not list any organizations where the name or character indicates the race, sex, color, religion, national
origin or ancestry of its members.

List Extracurricular Activities which you can and are willing to direct.

Have you ever been convicted of a crime (misdemeanor or felony), other than a minor traffic No
violation?
If yes explain

Are there criminal charges currently pending against No

you?
If yes explain

Have you ever entered a plea of no contest or been convicted of any offense involving criminal sexual
conduct, attempted criminal sexual conduct, assault with intent to commit criminal sexual conduct,
felonious assault on a child, cruelty, torture or indecent exposure involving a child?

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No
If yes explain

Have you ever been discharged, requested to resign from a position, or entered into a severance or
resignation agreement?
No
If yes explain

Have you ever been denied tenure, had a certificate or license revoked or No
suspended?
If yes explain

JOB INTERESTS
Instructional:
Teacher SubTeacher
Administration:
Principal Assistant Principal Director Department Supervisor Other
Support Services:
Custodian / Maint & Grounds X Food Service Paraprofessional (Teachers' Aide)
Secretarial / Clerical Bus Driver Noon Hour Supervisor Substitute in
Support
Services

REFERENCES
List three references who have first-hand knowledge of your character, personality, and working ability:

Name:
Position:
Address:

Phone:
Phone:

Name:
Position:
Address:

Phone:
Phone:

Name:
Position:
Address:
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Phone:
Phone2:

PROFESSIONAL STATEMENTS : TEACHER

APPLICANTS ONLY
What qualifications, abilities and strong points do you believe will help you succeed in the position for
which you have applied?

Facts

The facts set forth in my application for employment are true and complete. I hereby authorize my
references, local/state and national police agencies, and/or previous employers, unless otherwise noted in
the application, to provide information concerning my previous employment history, motor vehicle record,
criminal record history, fingerprint check and/or any related records.

I hearby waive my right to receive written notice with regard to the release of disciplinary action (including
any and all "unprofessional conduct") by my current or prior employers. Further, I release all such persons
who formerly employed me, persons providing a character reference and/or any schools I attended from
liability or damamges incurred as a result of furnishing the above

information. I understand that employment consideration is partially based upon the investigation of my
present and previous employment records, references, and upon successful completion of a post-job offer
physical examination which may include a drug screen. I understand that false statements,
misrepresentation, or omissions of facts or circumstances on this application and/or during my interivews
shall be considered sufficient cause for rejection of my application or discharge from employment at any
time.

Agreement (Read carefully before checking)

I certify the facts set forth in this application for employment are true and complete to the best of my
knowledge and belief. I further agree to permit the Port Huron School District to give any information
concerning me, as needed, and release them from any liability in furnishing such information. I
understand false statements or information provided on this application will result in cancellation of my
application or dismissal after employment. I agree to abide by the policies, regulations, and work rules
established by the Board of Education.

Information on File
Prior to hiring, you may be requested to have on file with the Assistant Superintendent of Human
Resources a complete set of original college/university transcript(s) of credit(s), placement file and
evidence of eligibility for Michigan certification, consent for Criminal Conviction History Report. Guest
teachers will be required to have on file copies of their teaching certificate, transcripts, social security
card, and drivers licence. I authorize the investigation of all references. I understand that
misrepresentation or omission of facts amy be cause for dismissal.

Do you agree with the above statements?

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WORK EXPERIENCE
Years of Public Teaching (or administrative) Experience in
Michigan:
Years of Experience in the support area of
interest:

ALL APPLICANTS
Employer:
Address:
City/State/Zip:
Job Title: Rate of Pay:
Supervisor: Telephone:
Start Date: (mm/yy) End Date:
(mm/yy)
Reasons for Leaving: Hours/Weeks:
General
Responsibilities:

Employer:
Address:
City/State/Zip:
Job Title: Rate of Pay:
Supervisor: Telephone:
Start Date: (mm/yy) End Date:
(mm/yy)
Reasons for Leaving: Hours/Weeks:
General Responsiblities:

Employer:
Address:
City/State/Zip:
Job Title: Rate of Pay:
Supervisor: Telephone:
Start Date: (mm/yy) End Date:
(mm/yy)
Reasons for Leaving: Hours/Weeks:
General

App Number: 20210079 Page 5 / 10 Printed 4/23/2021 1:22:41 PM

Responsibilities:

Employer:
Address:
City/State/Zip:
Job Title: Rate of Pay:
Supervisor: Telephone:
Start Date: (mm/yy) End Date:
(mm/yy)
Reasons for Leaving: Hours/Weeks:
General
Responsibilities:

ALL APPLICANTS
In applying here for employment, it is understood that the Port Huron School District must contact past
employers and/or their agents regarding references. May we also contact your present employer and/or its
agents at this time?

If No, Reason:

"I hereby request that previous employers and/or their agents contacted by the Port Huron School District
in connection with this application fully respond to all inquires concerning such previous employment and
specifically waive prior written notice of disclosure of my personnel record information including
disciplinary reports, letters of reprimands or other disciplinary action. In consideration of the acceptance
of my application, I release the Port Huron School District and previous employers and/or their agents of
any claim liability arising out of such response and disclosure.

I have read and agree to the above waiver.

If yes, type your name and proceed. If no, type your reason.

HIGH SCHOOL INFORMATION

High School Name: Port Huron High School
City/State: Port Huron MI Graduate: Yes
Start Date: September 2, 2014 End Date: (mm/yy) May 25, 2018
(mm/yy)
Grade Completed: 12 G.E.D. Yes
Extracurricular Activities: No
Offices, Honors/Awards: Academic pins, and a varsity letter

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COLLEGE INFORMATION
College University or
College City/State: Graduate:
Start Date: End Date:
(mm/yy) (mm/yy)
Degree: Degree Date:
GPA: Credits:
Major: Minor:

COLLEGE INFORMATION
College/University: or
City/State: Graduate:
Start Date: End Date:
(mm/yy) (mm/yy)
Degree: Degree Date:
GPA: Credits:
Major: Minor:

COLLEGE INFORMATION
College/University: or
City/State: Graduate:
Start Date: End Date:
(mm/yy) (mm/yy)
Degree: Degree Date:
GPA: Credits:
Major: Minor:

VOCATIONAL OR OTHER SCHOOL INFORMATION

Vocational or Other
School:

City/State: Graduate:
Start Date: End Date:
(mm/yy) (mm/yy)
Degree: Degree Date:
GPA: Credits:
Major: Minor:

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Major Hours: Minor Hours:
Do you Possess a Current:
License: Certificate:
Journeyman: CDL for Bus Driver:
Other:
Kind: Licensing Agent:
Date Acquired: Date Expires:

EDUCATION COMMENTS
Education Comments:

TEACHER AND ADMINISTRATOR APPLICANTS ONLY

Michigan Pendin
Certificate g:
If pending, do you have a 90-day Expires
letter? :
Date Issued or Expected:
Expires:

Be sure to include all areas of grade level and endorsements on the certificate.
Certificate #
Certification 1:
Certification 2:
Certification 3:
Certification 4:
Certification 5:
Certification 6:
Other State
Certification:
Other State Certification Description: Please note the state, grade levels, endorsements, and cetificate
expiration.

STUDENT TEACHING EXPERIENCE : TEACHER

APPLICANTS ONLY
App Number: 20210079 Page 8 / 10 Printed 4/23/2021 1:22:41 PM
First Experience
School district:
School:
Grade Level/Subject:
City/State:
Supervisor/Telephone:
University Supervisor/Telephone:
Extracurricular Activities:
Offices, Honors/Awards:
Weeks of Student Teaching: Start End
Date: Date:

Second Experience
School district:
School:
Grade Level/Subject:
City/State:
Supervisor/Telephone:
University Supervisor/ Telephone:
Extracurricular Activities:
Offices, Honors/Awards:
Weeks of Student Teaching: Start End
Date: Date:

GUEST TEACHING INFORMATION

I have been a guest teacher in the Port Huron School
District:

I am willing to be a guest
teacher:

1. I prefer to work in the following assignment areas:

2. I am available to work the following days and times:

Any Day / Any Time
Monday Full Day Monday AM Monday PM
Tuesday Full Day Tuesday AM Tuesday PM
Wednesday Full Day Wednesday AM Wednesday PM

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 Thursday Full Day Thursday AM Thursday PM
Friday Full Day Friday AM Friday PM

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