Substitute Application: Head Start/Early Head Start
Please complete the form below to apply to substitute with Region 9's Head Start or Early Head Start program.
Applicant Note
This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the completion of this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of race, color, religion, sex (including pregnancy, gender identify, and sexual orientation, national origin, age (40 or older), disability or genetic information in employment practices or the provision of services.)
Full Name
*
First Name
Last Name
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Available Start Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
How did you hear about us
*
Please Select
LinkedIn
Event
Social Media
Company Website
Family / Friend
Other
What program are you interested in substituting for?
*
Please Select
Early Head Start (6 weeks to 3 years old)
Head Start (3-4 years old)
Both
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Education
Type of Degree
*
Please Select
Less than HS diploma or GED
CDC
GED
HS Diploma
Associates
Bachelors
Masters
Ph.D
Major
Did you complete this degree?
*
Please Select
Yes
No
Date of completed degree or anticipated completion
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of School
Type of Degree
Please Select
Less than HS diploma or GED
CDC
GED
HS Diploma
Associates
Bachelors
Masters
Ph.D
Major
Did you complete this degree?
Please Select
Yes
No
Date of completed degree or anticipated completion
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of School
Type of Degree
Please Select
Less than HS diploma or GED
CDC
GED
HS Diploma
Associates
Bachelors
Masters
Ph.D
Major
Did you complete this degree?
Please Select
Yes
No
Date of completed degree or anticipated completion
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of School
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Additional Information
Have you used any names other than those on this application? If yes, please list below. If not, please type N/A.
List languages in which you are fluent.
*
Please list any other skills, licenses or certificates that may be job related.
I understand that a Substitute Guide/Binder is located in all Head Start/Early Head Start classrooms for my review.
*
Yes
No
Do you understand the requirements of substituting?
*
No
Yes
I understand that I may ask questions at anytime to clarify my responsibilities.
*
Yes
No
I understand that I must sign in daily when I am substituting for Head Start & Early Head Start. This document is located in the office or classroom. I will include the name of the person I am substituting for. I understand that failure to do so may delay payment.
*
Yes
No
Do you know anyone that works for our organization?
Yes
No
Have you previously worked for Region 9?
Yes
No
Are you eligible to work in the U.S.?
Yes
No
Are you at least 18 years or older?
*
No
Yes
Have you been terminated from employment or asked to resign by an employer?
*
Yes
No
If yes, provide company name and details.
I understand that the rate of pay is as follows: $12.00 hour
*
Yes
No
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House Bill 128 Questionnaire
Have you ever been employed in a position involving unsupervised contact with children or students.
Yes
No
HB 128
Please list ALL current and previous employers and/or volunteer organizations, including any position you held with unsupervised access with children or students.
Employer 1
Name of School or Entity
Address of Employer
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of School or Entity Representative
Please enter a valid phone number.
Format: (000) 000-0000.
Email of School Contact
example@example.com
Employer 2
Name of School or Entity
Address of Employer
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of School or Entity Representative
Please enter a valid phone number.
Format: (000) 000-0000.
Email of School Contact
example@example.com
Employer 3
Name of School or Entity
Address of Employer
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of School or Entity Representative
Please enter a valid phone number.
Format: (000) 000-0000.
Email of School Contact
example@example.com
Employer 4
Name of School or Entity
Address of Employer
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of School or Entity Representative
Please enter a valid phone number.
Format: (000) 000-0000.
Email of School Contact
example@example.com
Employer 5
Name of School or Entity
Address of Employer
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of School or Entity Representative
Please enter a valid phone number.
Format: (000) 000-0000.
Email of School Contact
example@example.com
If you need more room for more employers, please use this text box to enter all required information (Name of Entity, Address, Phone Number, Email of School Contact)
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HB 128
Additional Questions
[Have you] ever been under investigation for, or has been found to have violated, any state or federal statute relating to child abuse or neglect, sexual misconduct or any sexual offense, including those offenses prohibited in Chapter 30, Article 3, 3A, 4, 6, 6A, 9, 37, 37A or 52 NMSA 1978, unless the allegations were false or unsubstantiated;
*
Yes
No
[Have you] ever been under investigation for, or found to have violated, any ethical rule or policy approved by a former employer that previously employed the applicant, unless the allegations were false or unsubstantiated;
*
Yes
No
[Have you] ever had a professional license or certificate denied, suspended, surrendered or revoked due to a finding of child abuse or ethical misconduct or while allegations of child abuse or ethical misconduct were pending or under investigation;
*
Yes
No
DO YOU AGREE to allow Region 9 Education Cooperative to: conduct a review of the applicant's employment history and contact the applicant's current and former employers listed under Subsection A of this section and request: (1) the applicant's dates of employment; and (2) a written statement describing whether the applicant: (a) has ever been under investigation for, or has been found to have violated, any state or federal statute relating to child abuse or neglect, sexual misconduct or any sexual offense, including those offenses prohibited in Chapter 30, Article 3, 3A, 4, 6, 6A, 9, 37, 37A or 52 NMSA 1978, unless the allegations were false or unsubstantiated; (b) has ever been under investigation for, or found to have violated, any ethical rule or policy approved by a former employer that previously employed the applicant, unless the allegations were false or unsubstantiated; or (c) has ever had a professional license or certificate denied, suspended, surrendered or revoked due to a finding of child abuse or ethical misconduct or while allegations of child abuse or ethical misconduct were pending or under investigation. AND DO YOU AGREE An applicant's current or former employer shall disclose the information requested under Subsection B of this section within thirty days of receiving the request.
Yes
No
By initialing below, I agree that I have read and approve of the statement above.
*
Printed Name
First Name
Last Name
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Required Documents
Please upload files in PDF format
Upload Your Resume
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload your Cover Letter
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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References
Please list 3 professional references and their emails
Reference's Name
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference's Name
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference's Name
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Employment History Affidavit
Most positions with Region 9 Education Cooperative involve contact with our student population. You must provide the information below to help us evaluate your suitability to perform in this capacity. As with the rest of this application, any misrepresentation or omission of fact may be grounds for disqualification or discharge, regardless of when the misrepresentation or omission is discovered. An affirmative answer provided by you on this is NOT an automatic bar to employment. Region 9 Education Cooperative will consider the nature of any alleged conduct underlying an affirmative response, the date of the alleged conduct in question, your intervening conduct, and the relationship between the alleged conduct underlying the affirmative response and the position for which you are applying. If the alleged conduct is directly related to the position for which you have applied, you may be required to provide additional information.
Have you ever been reprimanded?
*
Yes
No
Have you ever been disciplined for misconduct?
*
Yes
No
Have you ever been discharged for misconduct?
*
Yes
No
Have you ever resigned, or been asked to resign from a prior position for misconduct?
*
Yes
No
Have you ever resigned from a prior position without being asked, but under circumstances involving your employer's investigation of inappropriate sexual contact with another person?
*
Yes
No
Have you ever resigned from a prior position without being asked, but under circumstances involving your employer's investigation for sexual abuse of another person?
*
Yes
No
If you have answered 'yes' to any of the questions above, please explain in detail in the text box below. Be sure to include the date of the misconduct in question.
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Additional Information
Are you a current HS/EHS parent or guardian?
*
Please Select
YES
NO
Why do you want to substitute at EHS/HS? Do you have any previous experience working with children? Please explain.
*
Have you ever been convicted of a felony and/or service time in the past 7 years?
*
Please Select
YES
NO
Have you had an arrest or substantial referral to a child protective services agency?
*
Please Select
YES
NO
If you answered YES to the either of these two questions, please describe the incident below. Please include the incident, the city & state it occurred in and the charge.
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Review of Application
Please thoroughly review your application before submitting.
REC 9 does not discriminate on the basis of race, color, national origin, ancestry, sex, religion, age, handicap/disability, serious medical condition, equal compensation, genetic information, pregnancy, sexual orientation, gender identity, veteran status, marital status or spousal affiliation in employment practices or the provision of services.
Certification and Release: I certify that I have read and understand the applicant note on this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damages whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment.
By initialing below, you agree to this certification and release.
Initials Agreeing with Above Statement
*
Printed Name
First Name
Last Name
Date
Applicants, including those for temporary positions, are subject to work history and education verification checks, as well as reference investigations. Finalists will also be subject to a criminal background check, including mandatory fingerprinting, as a condition of further consideration for employment. Additionally, all offers of employment are contingent upon the satisfactory completion of background investigations. Criminal convictions shall not automatically bar an applicant from obtaining employment with the district;however, pursuant to the Criminal Offender Employment Act, NMSA 1978 § 28-2-4 and 28-2-5, they may be a basis for refusing employment.
I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons or entities from any liability for any damage whatsover for issuing this information.
I understand that an offer and acceptance of employment is not a contract for employment. Any employment agreements will only be valid and binding when the agreement is expressly set forth in a written document signed by an authorized representative of Region 9 Education Cooperative.
Print Name of Applicant
*
First Name
Last Name
Other Availability Information:
This signature acknowledges that all information provided in this application is accurate to the best of my knowledge.
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Apply
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