APPLICATION FOR SUBSTITUTE TEACHER

APPLICATION FOR SUBSTITUTE TEACHER
An Equal Opportunity Employer*
Date of application

MonthDayYear
Date
Name

First NameMiddle InitialLast Name
Mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail address
example@example.com
Home phone
Format: (000) 000-0000.
Cell phone
Format: (000) 000-0000.
Other phone
Format: (000) 000-0000.
Other name that may appear on records
(Used for certification, reference, and criminal history record checks)
Are you receiving Teacher Retirement System (TRS) retirement benefits?
Are you employed as a part-time employee by a TRS-covered employer?
(Required to determine if the district will be assessed a monthly surcharge as required by TRS rules.)
Please list the days you are available to substitute and your assignment preferences.
Day(s) of week
Assignment Type
Preferred campuses:
Have you been employed by PISD in the past?
If you answered yes, provide dates of employment
List the highest level of education attained:
Licenses and certificates granted

Rows	Name and location of schools attended	Course of study and major/minor	Diploma, degree, certificate, or license granted	Year graduated (College only)

APPLICATION FOR SUBSTITUTE TEACHER
Certificates or Licenses Currently Held:

Other
Category/Level(s) of Certification:
Areas of Specialization/Supplemental Certificates/Endorsements (as listed on certification):
List teaching experience beginning with most recent years. Attach additional sheets if necessary.
1.)Name and location of school
Type of assignment
Dates taught
Principal's name and phone
Reason for leaving
2.)Name and location of school
Type of assignment
Dates taught
Principal's name and phone
Reason for leaving
3.)Name and location of school
Type of assignment
Dates taught
Principal's name and phone
Reason for leaving
4.)Name and location of school
Type of assignment
Dates taught
Principal's name and phone
Reason for leaving

APPLICATION FOR SUBSTITUTE TEACHER
Provide a list of all other jobs or administrative positions you have held in the past 10 years. Attach additional sheets if necessary. Attach résumé if available.
1.)Employer name and location
Position/title held
Dates employed
Supervisor's name and phone
Reason for leaving
2.)Employer name and location
Position/title held
Dates employed
Supervisor's name and phone
Reason for leaving
3.)Employer name and location
Position/title held
Dates employed
Supervisor's name and phone
Reason for leaving
4.)Employer name and location
Position/title held
Dates employed
Supervisor's name and phone
Reason for leaving

List references the district can contact regarding your work history.

Rows	Full name of reference	School district/ firm name	Mailing address	Position/title	Area code/ phone

APPLICATION FOR SUBSTITUTE TEACHER
Have you ever been convicted of, pled guilty or no contest (nolo contendre) to, or received probation, suspension, or deferred adjudication for a felony or any offense involving moral turpitude (including, but not limited to, theft, rape, murder, swindling, and indecency with a minor)?
If yes, please state where, when, and the nature of the offense
(A felony conviction is not an automatic bar to employment. The district will consider the nature, date, and relationship between the offense and the position for which you are applying.)
I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge and understand that any deliberate falsifications, misrepresentations, or omissions of fact may be grounds for rejection of my application or dismissal from sub sequent employment.
I authorize the references listed on the previous page to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all such parties from liability for any damage that may result from furnishing the same to you.
I understand that the district is required by Texas Education Code to review criminal history record information of substitute teachers.
I understand that I am required to report any outside employment with a TRS-covered employer to the district and provide a monthly record of hours worked so the district can determine if it will be subject to the monthly surcharge.
Signature
Date

MonthDayYear
Date
This application becomes the property of the district. The district reserves the right to accept or reject it.
*Applicants for all positions are considered without regard to race, color, sex (including pregnancy, sexual orientation, or gender identity), national origin, religion, age, disability, genetic information, veteran or military status, or any other legally protected status. Additionally, the district does not discriminate against an applicant who acts to oppose such discrimination or participates in the investigation of a complaint related to a discriminating employment practice.
Should be Empty:

APPLICATION FOR SUBSTITUTE TEACHER

An Equal Opportunity Employer*

APPLICATION FOR SUBSTITUTE TEACHER

APPLICATION FOR SUBSTITUTE TEACHER

APPLICATION FOR SUBSTITUTE TEACHER