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396240-2387605747385-182880George County School DistrictLucedale, MS 39452Phone 601-947-6993/Fax 601-766-6347SUBSTITUTE APPLICATIONTeacher ________ Janitorial ________ Bus Driver ________ Clerical ________ Nurse ________Date of Application: ________________________Name:_______________________________________________________ Soc. Sec.#. _____________________________Address:_____________________________________________________ Phone #:_______________________________City: ______________________________________ State: _________ Zip: _________ Cell #:______________________E-Mail Address: _______________________________________________________________________________________--Are you a member of the Mississippi Public Employees’ Retirement System? _____Yes _____ No--Are you a retired member of the Mississippi Public Employees’ Retirement System? _____Yes _____No--Do you have a degree from a 4-year University? ____ Yes (If yes, must attach copy of degree/teacher license) ____ No References/Reference Form Recipients (At least one reference must be from George County):Name____________________________________________ Phone No.____________________________Name____________________________________________ Phone No.____________________________Name____________________________________________ Phone No.____________________________List any school in which you would prefer not to substitute:________________________________________By signing this application, I understand that I must be cleared by and have on file in this office, a criminal record background check and a current child abuse registry check before I can work as a sub. This process includes fingerprinting and FBI national criminal history check which is done in this office each Thursday from 2:00 – 4:00 pm. A fee of $36.00 (exact change/check) is due prior to the applicant being fingerprinted.____________________________________________________________ __________________________________Signature of Applicant DateApplication Checklist – All items must be received for your application to be submitted for Board Approval at our next scheduled board meeting.All Applicants: Clerical/Teacher: Bus Driver:_____Completed Application ____GED/High School Diploma ____CDL License with B Endorsement_____Social Security Card_____Driver’s License Nurse:_____3 Reference Forms ____ License_____I-9 Form_____Direct Deposit Form (Attach a VOIDED Check)_____Fingerprinted (Thurs 2:00 – 4:00)Received by: ______________________________________________________ Date: __________________________245110-55880George County School District6480175-412115REFERENCE FORMPart I. Applicant Information- Part I should be completed by the applicant.Applicant’s Name: _____________________________________________________Date:_________________________________________________________Applicant’s Phone Number: Dear ______________________________________________________________________I am submitting an employment application to the George County school District and I have listed your name as a reference. I will appreciate your assistance in completing this form and returning it directly to the school district via mail or fax. It is my understanding that all information herein will be kept confidential.___________________________________________________________________________________Signature of ApplicantPosition for which I am applyingPart II. The person making the recommendation will complete the remainder of this form and return to:Human Resources DepartmentGeorge County Schools5152 Main StreetLucedale, MS 39452Please indicate by a check in the appropriate column the rating which best describes the applicants qualifications.PERSONAL/PROFESSIONALQUALIFICATIONSSUPERIORABOVE AVERAGEAVERAGEBELOW AVERAGEUNKNOWNAppearancePersonalityResponsibility/DependabilityCooperation/LoyaltyProfessional AttitudeClassroom ControlSkill in TeachingInterest in Children/TeachingProfessional Growth/ImprovementAccepts ChangeProbable Success in PositionThis evaluation includes the approximate time period from ___________________ to __________________.In what capacity have you known this applicant? __________________________________________________________________________________________________________________________________________Would you offer this applicant employment or re-employment? _____________________________________Comments: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________SignatureTitle_________________________________________________________________________________TelephoneSchool/Company245110-55880George County School District6480175-412115REFERENCE FORMPart I. Applicant Information- Part I should be completed by the applicant.Applicant’s Name: _____________________________________________________Date:_________________________________________________________Applicant’s Phone Number: Dear ______________________________________________________________________I am submitting an employment application to the George County school District and I have listed your name as a reference. I will appreciate your assistance in completing this form and returning it directly to the school district via mail or fax. It is my understanding that all information herein will be kept confidential.___________________________________________________________________________________Signature of ApplicantPosition for which I am applyingPart II. The person making the recommendation will complete the remainder of this form and return to:Human Resources DepartmentGeorge County Schools5152 Main StreetLucedale, MS 39452Please indicate by a check in the appropriate column the rating which best describes the applicants qualifications.PERSONAL/PROFESSIONALQUALIFICATIONSSUPERIORABOVE AVERAGEAVERAGEBELOW AVERAGEUNKNOWNAppearancePersonalityResponsibility/DependabilityCooperation/LoyaltyProfessional AttitudeClassroom ControlSkill in TeachingInterest in Children/TeachingProfessional Growth/ImprovementAccepts ChangeProbable Success in PositionThis evaluation includes the approximate time period from ___________________ to __________________.In what capacity have you known this applicant? __________________________________________________________________________________________________________________________________________Would you offer this applicant employment or re-employment? _____________________________________Comments: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________SignatureTitle_________________________________________________________________________________TelephoneSchool/Company245110-55880George County School District6480175-412115REFERENCE FORMPart I. Applicant Information- Part I should be completed by the applicant.Applicant’s Name: _____________________________________________________Date:_________________________________________________________Applicant’s Phone Number: Dear ______________________________________________________________________I am submitting an employment application to the George County school District and I have listed your name as a reference. I will appreciate your assistance in completing this form and returning it directly to the school district via mail or fax. It is my understanding that all information herein will be kept confidential.___________________________________________________________________________________Signature of ApplicantPosition for which I am applyingPart II. The person making the recommendation will complete the remainder of this form and return to:Human Resources DepartmentGeorge County Schools5152 Main StreetLucedale, MS 39452Please indicate by a check in the appropriate column the rating which best describes the applicants qualifications.PERSONAL/PROFESSIONALQUALIFICATIONSSUPERIORABOVE AVERAGEAVERAGEBELOW AVERAGEUNKNOWNAppearancePersonalityResponsibility/DependabilityCooperation/LoyaltyProfessional AttitudeClassroom ControlSkill in TeachingInterest in Children/TeachingProfessional Growth/ImprovementAccepts ChangeProbable Success in PositionThis evaluation includes the approximate time period from ___________________ to __________________.In what capacity have you known this applicant? __________________________________________________________________________________________________________________________________________Would you offer this applicant employment or re-employment? _____________________________________Comments: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________SignatureTitle_________________________________________________________________________________TelephoneSchool/Company ................
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