Dear:
APPLICATION
SUBSTITUTE TEACHER
Date of Application: ________________ E-mail Address: ________________________
Home Telephone #: _____________________ Business Telephone #: ___________________
Name: ______________________________________________________________________________
Address: _________________________________________________________________________
No. Street Name
.________________________________________________________________________
City, State, Zip Code
Graduate of: ___________________________ Date: ___________
Degree: __________________ Major: _________________ Minor: __________
Currently hold valid Connecticut Certification: ( Yes ( No
Certified in: _____________________________ Expiration Date: _______________________
Eligible for Connecticut Certification: ( Yes ( No
Previous teaching/substituting experience: ___________________________________
.__________________________________________________________________________________
.__________________________________________________________________________________
Please submit/attach Academic Transcript.
AVAILABILITY
|DAYS |TIMES |PREFERRED SCHOOL |PREFERRED GRADE OR SUBJECT |
| | | | |
| | | | |
| | | | |
|REFERENCES |Give the names of three persons not related to you, who have known you for at least one year |
|Name |Telephone Number |Address |Years Acquainted |
|1. | | | |
|2. | | | |
|3. | | | |
|GENERAL INFORMATION |YES |NO |
|Have you ever been convicted of a crime or do you have any criminal charges pending against you? {A yes answer does not | | |
|automatically disqualify you from employment}. If yes, please explain in writing and attach. | | |
All personnel actions, including the recruitment of new employees and decisions affecting current employees, are administered without regard to race, color, religion, sex, disability, age, marital status or national origin.
I certify that the facts contained in this application are true and complete to the
best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements and references listed above.
Date: __________________ Signature of Applicant: _____________________
Before submitting an application, please read and sign the following:
I authorize the Southington Board of Education to make any investigation of my personal and employment history and authorize any former employer, person, firm, corporation, or government agency to give the Southington Board of Education any information they may have regarding me. In consideration of the Southington Board’s review of this application, I release the Southington Board of Education, its agents and employees and all providers of information from any liability as a result of furnishing and receiving this information.
Date: _____________ Signature of Applicant: _____________________________
Original applications should be submitted to:
Southington Public Schools
Personnel Department
49 Beecher Street
Southington, CT 06489
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Southington Public Schools
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