Personnel Services
|[pic] |Human Resource Services |
| |Certificated Substitute Profile Sheet |
| | |
|I acknowledge my appointment and wish to serve as a substitute teacher for the ______ school year. Fax back to: |[pic] |
|(916) 643-9454. | |
|I wish to place the following restriction(s) on my substitute assign-ments. I understand that I may remove these | |
|restrictions at any time during the school year. | |
PROGRAM RESTRICTIONS: (If you have no restrictions, check “No Restrictions.”)
|( No Restrictions |( Restriction: Regular Education/Specify Specific Subject Area(s): |
|( Restriction: Adult Education | |
|( Restriction: Children’s Center Programs | |
|( Restriction: Special Education | |
SITE RESTRICTIONS:
Will you work at ALL sites? ( Yes ( No
If no, please enter sites where you wish to restrict yourself from working:
| | | | | |
DAYS OF THE WEEK RESTRICTIONS:
I am available Monday through Friday: ( Yes ( No
If no, I am only available on:
( Monday ( Tuesday ( Wednesday ( Thursday ( Friday
|CREDENTIAL: Please indicate California credential(s) you have: |Expiration Date |
| | |
| | |
|NAME: (Please Print) |
|PHONE: |
|ADDRESS: |
| Street City Zip |
|EMAIL ADDRESS (Print Clearly) |
|SOCIAL SECURITY NUMBER (Last six digits only): |
|DATE AVAILABLE TO START*: |
|Are you a student teacher? |( Yes ( No |If so, where: | |
|Signature: | |Date: |
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