HUERFANO SCHOOL DISTRICT RE-1
Huerfano School District Re-1
201 East Fifth Street
Walsenburg, Colorado
Telephone (719) 738-1520 Fax (719) 738-3148
SUBSTITUTE TEACHER APPLICATION
PERSONAL
Name
Address
City/State/Zip
Telephone No.
Please check the school(s) that you would like to substitute teach:
Peakview School (PreK-Eighth Grades)
Gardner School (PreK-Eighth Grades)
John Mall High School (Ninth-Twelfth Grades)
Do you hold a Colorado Teaching Professional License? Yes No
(Please attach a copy of your license)
Endorsement (Colorado Professional License) Expiration Date
Any bilingual/bicultural assets?
EDUCATION
Name of School/College Location Did you Graduate? Degree/Diploma *
High School
College/
University
College/
University
* Please attach a copy of your High School Diploma or GED Certificate, as mandated by Colorado State Law.
EXPERIENCE
Contract Teaching
School/City/State Grades/Subjects Taught Years Experience Dates
REFERENCES
Persons familiar with your teaching abilities:
Name Address/Telephone Title/Occupation
Substitute, student teaching or other related experience:
Add any additional information which you believe will assist in arriving at a better understanding of your qualifications and abilities:
Have you ever been convicted of a felony? Yes No
If yes, please explain
Have you ever been suspended or dismissed from a teaching position for cause? Yes No
If yes, please explain
The Huerfano School District Re-1 does not unlawfully discriminate on the basis of race, color, religion, national origin, gender, age, or disability in its admission or access to, or treatment, or employment in, its educational programs or activities. Inquiries may be referred to Superintendent of Schools, Section 504/ADA Coordinator, Huerfano School District RE-1, 201 East Fifth Street, Colorado 81089 (719) 738-1520.
I hereby certify that the information presented on this form is true, accurate and complete. Any falsification or omission will be sufficient cause for disqualification or dismissal.
Signature of Applicant Date
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