Substitute Compensation Request
* Please be advised that a new submission should be filled out for each department subbed for
Is substitute a current employee at the school?
*
Yes
No
Department substituted for
*
Please Select
Kindergarten
Politz Yeshiva Limudei Kodesh
Politz Yeshiva General Studies
Politz Bais Yaakov Limudei Kodesh
Politz Bais Yaakov General Studies
Substitute Information
Name
*
First Name
Last Name
E-mail Address
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Description
Is substitute substituting during their regular employment hours?
*
Yes
No
Is substitute an assistant substituting for a main teacher?
*
Yes
No
What number time is it substituting for the main teacher?
*
1-5
6+
Teacher Subbing For
*
Grade Subbing For
*
Date Substituted
*
/
Month
/
Day
Year
Date
Time
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Total 0.0
Compensation
$
Would you like to add another instance?
*
Yes
No
Is substitute substituting during their regular employment hours?
*
Yes
No
Is substitute an assistant substituting for a main teacher?
*
Yes
No
What number time is it substituting for the main teacher?
*
1-5
6+
Teacher Subbing For
*
Grade Subbing For
*
Date Substituted
*
/
Month
/
Day
Year
Date
Time
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Total 0.0
Compensation
$
Would you like to add another instance?
*
Yes
No
Is substitute substituting during their regular employment hours?
*
Yes
No
Is substitute an assistant substituting for a main teacher?
*
Yes
No
What number time is it substituting for the main teacher?
*
1-5
6+
Teacher Subbing For
*
Grade Subbing For
*
Date Substituted
*
/
Month
/
Day
Year
Date
Time
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Total 0.0
Compensation
$
Total Compensation
$
Today's Date
-
Month
-
Day
Year
Date
Form Submitted By
*
Please Select
Mrs. Horowitz
Rabbi Yoseif Rich
Miss Leah Reiner
Mrs. Dina Schon
Mrs Steinig
Email
*
example@example.com
Submit
Should be Empty: