Substitute Application

USD 112 CENTRAL PLAINS
Substitute Application
Unified School District 112, 406 Main St., Box 176, Claflin, KS 67525 620-588-4200
Name
Date

MonthDayYear
Date
Address
City/State
Social Security#
Phone
Format: (000) 000-0000.
Email address
example@example.com
Cell
Level Preferred
Teaching areas preferred
Teaching Experience
1.
2.
3.
Date and place of last teaching position

MonthDayYear
Date
Place
Education
College or University Degree (BS+years or MS+years)
Major
Minors
Degree earned from
Other colleges or universities attended
Certification Level
Date Issued

MonthDayYear
Date
Expiration Date

MonthDayYear
Date
Please attach a copy of your current teaching license

Cancelof
References
First Name Last Name Email Phone Number
First Name Last Name Email Phone Number
First Name Last Name Email Phone Number
Signature

Clear
Should be Empty:

Teaching Experience