PANTHER VALLEY SCHOOL DISTRICT



PANTHER VALLEY SCHOOL DISTRICT

1 PANTHER WAY

LANSFORD, PA 18232

(570) 645-4248 (phone) (570) 645-6232 (fax)

2012-2013 SUBSTITUTE TEACHING APPLICATION 2012-2013

_____________________________________________________________

I, ____________________________, hereby consent to substitute in subject matter areas outside those listed on my professional Pennsylvania certificate with the exception of any specific areas listed below.

_______________________________________ ________________________

SIGNATURE DATE

Area(s) of exception, i.e. area(s) in which I do not want to substitute, are: ____________ _______________________________________________________________________

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FOR SCHOOL DISTRICT USE

Your consent having been indicated above and having determined that no appropriately certified individual is available to fill the substitute position open on the date(s) indicated below, you have been granted an emergency certificate for service as a day-to-day substitute outside the areas of certification on your professional Pennsylvania certificate.

DATE SUBJECT SIGNATURE

_____________________ ______________________ __________________

_____________________ ______________________ __________________

_____________________ ______________________ __________________

_____________________ ______________________ __________________

SUBSTITTUTE TEACHER AVAILABILITY FORM

Calls:_________a.m. ____________p.m.

Name:_____________________________ Social Security #:_____________________

Address:___________________________ Areas(s) of Certification:_______________

__________________________________ ___________________________________

zip code ___________________________________

Telephone # ( )__________________

___________________________ _____________________

SIGNATURE DATE

If your availability changes, please contact the Administration Office at (570) 645-4248.

I will be available to do the following types of employment:

A. Full-time________ B. Part-time__________

FROM TO

Monday a.m. a.m.

p.m. p.m.

________________________________________________________________________

Tuesday a.m. a.m.

p.m. p.m.

________________________________________________________________________

Wednesday a.m. a.m.

p.m. p.m.

________________________________________________________________________

Thursday a.m. a.m.

p.m. p.m.

________________________________________________________________________

Friday a.m. a.m. p.m. p.m.

________________________________________________________________________

Short term teaching ______ yes _______ no

Long term teaching ______ yes _______ no

On-Call Substitute Teacher ______ yes _______ no

Homebound Instruction ______ yes _______ no

Able to teach grades K through 12 ______ yes

If no, indicate grades you will not teach ____________________________________.

Grade preference – check area(s) you desire to teach: Kindergarten _______,

Primary (1 –3)______, Intermediate (4 – 6)_______, Secondary (7 – 12)________.

A copy of your Pennsylvania teaching certificate must be on file with our school district in order to be on our substitute list – Also a current Physical complete

with TB results is mandatory. FBI Clearances complete with fingerprints are now mandatory.

Do you have any domestic or other personal considerations that would limit your availability? _____ yes _______ no, if yes, explain:

Comments:

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