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: ____________ _______________________________________________________________________
************************************************************************
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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