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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