Substitute Teacher Application

Substitute Teacher Application
Applicant Information
Name*

First NameMiddle InitialLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Date Available*

MonthDayYear
Social Security Number*
Position Applied For*
Are you a citizen of the United States?*

YesNo
Are you authorized to work in the United States?

YesNo
Have you ever worked for the school district?*

YesNo
When?
Have you ever been convicted of a felony?*

YesNo
Please explain.

Education
Please indicate all attended

High SchoolCollegeGraduate School

High School
High School
Address of High School

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From Date to Date .
Did you graduate?

YesNo
Diploma

College
College
Address of College

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From Date to Date .
Did you graduate?

YesNo
Degree

Graduate School
Graduate School
Address of Graduate School

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From Date to Date .
Did you graduate?

YesNo
Degree

Certification
Do you have your teaching certification?

YesNo
State of Certification
Subject Area of Certification
Expiration Date of Certification

MonthDayYear

References

Reference #1
Name of Reference #1*

First NameLast Name
Relationship with Reference #1*
Company of Reference #1*
Phone Number of Reference #1*

Area CodePhone Number
Address of Reference #1*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email of Reference #1*
example@example.com

Reference #2
Name of Reference #2*

First NameLast Name
Relationship with Reference #2*
Company of Reference #2*
Phone Number of Reference #2*

Area CodePhone Number
Address of Reference #2*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email of Reference #2*
example@example.com

Reference #3
Name of Reference #3*

First NameLast Name
Relationship with Reference #3*
Company of Reference #3*
Phone Number of Reference #3*

Area CodePhone Number
Address of Reference #3*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email of Reference #3*
example@example.com

Employment History

Previous Position #1
Company #1
Phone Number #1

Area CodePhone Number
Address Position #1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor Position #1

First NameLast Name
Job Title Position #1
Position #1 Employed from Date to Date .
Responsibilities Position #1
May we contact your supervisor from Position #1 for a reference?

YesNo

Previous Position #2
Company #2
Phone Number Position #2

Area CodePhone Number
Address Position #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor Position #2

First NameLast Name
Job Title Position #2
Position #2 Employed from Date to Date .
Responsibilities Position #2
May we contact your supervisor from Position #2 for a reference?

YesNo

Previous Position #3
Company #3
Phone Number Position #3

Area CodePhone Number
Address Position #3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor Position #3

First NameLast Name
Job Title Position #3
Position #3 Employed from Date to Date .
Responsibilities Position #3
May we contact your supervisor from Position #3 for a reference?

YesNo

Military Service
Have you ever served in the U.S. Military?*

YesNo
Branch
From Date to Date .
Rank at Discharge
Please check the box if your discharge was

Honorable or Under Honorable Conditions (General)Other
Please explain the nature of your discharge

Disclaimer and Signature
Please check the box to indicate agreement

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature

Clear
Date

MonthDayYear
Should be Empty: