Substitute Application
A Launch Pad For Learning And Life
Personal Information
Full Name
First Name
Middle Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Positions for which you are applying
Early Childhood Substitute (Prek-K)
Lower Elementary Substitute (1st-3rd)
Intermediate Substitute (4th-6th)
Junior High Substitute (7th-8th)
Educational Background
Please let us know about your educational experience
High School Experience
College Experience
Name of School/ University
Major/ Minor
Degree Earned or Hours Completed
College/University
College/University
College/University
Other Qualifications/Honors/Awards/Skills
Summarize special job-related skills and qualifications acquired from employment or other experiences (including U.S. military service) and/or state any additional information you feel may be helpful in considering your application, i.e. honors, awards, activities, technology skills or specialized professional development activities.
Interest Statement
Please let us know why you are working with children and why you are interested in working at John Rex.
Background Information
You must give complete answers to all questions. If you answer "Yes" to any question, you must list all offenses, and for each conviction provide date of conviction and disposition, regardless of the date or location of occurrence. Conviction of a criminal offense is not a bar to employment in all cases. Each case is considered on its merits. Your answers will be verified with appropriate police records.
Yes/No
Were you ever convicted of a criminal offense?
Yes
No
Are you currently under charges for a criminal offense?
Yes
No
Have you ever forfeited bond or collateral in connection with a criminal offense?
Yes
No
Within the last ten years, have you been fired from any job for any reason?
Yes
No
With in the last ten years, have you quit a job after being notified that you would be fired?
Yes
No
Have you been professionally disciplined in any state?
Yes
No
Are you subject to any visa or immigration status, which would prevent lawful employment?
Yes
No
If you answered “yes” to any of the above questions, provide date, incident, specific charge, city/state in which occurred:
Background Check and Fingerprinting for Employment
Each prospective employee (an individual who has received an offer of temporary employment by John Rex Charter School pending the results of the national criminal history record check) must submit a copy of a National Criminal History Record Check from the Federal Bureau of Investigation and a copy of fingerprint background report prior to employment at JRCS. Prospective employees must submit the ORIGINAL reports, which may not be more than one year old.
Statement of Certification
APPLICANT SIGNATURE: By signing this application, I certify that the information provided anywhere in this application is true, correct and complete to the best of my knowledge and belief, I acknowledge that should investigation at any time disclose any misrepresentation or falsification, my application may be rejected, my name may be removed from further consideration, and I may be disqualified from future examination and/or terminated from employment. I authorize John Rex Charter School to make all necessary and appropriate investigations allowable by law to verify the information provided:
Date
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Month
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Day
Year
Date
Signature
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