An Equal Opportunity Employer OYMENT APPLICATION FOR SUBSTITUTE TEACHER
3–4 EMPLOYMENT APPLICATION FOR SUBSTITUTE TEACHER
We consider applicants for all positions without regard to
race, color, national origin, age, religion,
sex, marital status, veteran or military status,
disability, or any other legally protected status.
Date of application _________________ Social Security
number____________________
Name____________________________________________________________________
Last First
Middle
initial
Current address
___________________________________________________________
Street/Box
City
State ZIP Code
Other address where you may be reached _______________________________________
Work phone _________________________ Home phone
_________________________
Other name that may appear on
records_________________________________________
Used for
certification, reference, and criminal history record checks)
Credentials included with application:
______ Résumé
______ All teaching and professional certificates or
licenses
______ All transcripts showing degrees
Have you been employed by Holland ISD in the past? _____Yes
_____No
If you answered yes, provide dates of employment______________________
Education
Check the highest level of education attained:
_____High school graduate ______GED Less than two
years of college
_____Less than two years of college ______Two or more years of college
_____Bachelor’s degree ______Master’s degree
Other training or education ____________________________________________________
EMPLOYMENT APPLICATION FOR SUBSTITUTE TEACHER
Certification
Certificate or License Currently Held:
______None
______Valid Texas Teaching Certificate
______Valid Texas Paraprofessional Certificate (Educational
Aid)
Other certifications or licenses: _______________________
_______________________
Work Experience
List work experience beginning with most recent years.
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Name and location
of company
Type of
assignment
Dates
taught
Reason for leaving
Other Work Experience
Please 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.
School district/firm name Position/title Dates employed
Reason for leaving
EMPLOYMENT APPLICATION FOR SUBSTITUTE TEACHER
©
3–4.11
Assignment Preference
Please list the days you are available to substitute and
your assignment preferences.
Day(s) of week Every day or only the following:
Monday Tuesday Wednesday Thursday Friday
Assignment Any or only the following:
Elementary Intermediate Secondary Special Education
Preferred campuses
_______________________________________________________
_______________________________________________________________________
Are you receiving Texas Teacher Retirement (TRS) benefits? Yes No
(The amount of time that an individual
receiving TRS benefits may be employed without affecting benefits is
governed by TRS rules and laws.)
General Information
Have you ever been convicted of, plead 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)? Yes No
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.)
References
Please list references the district can contact regarding
your work history. Include all managers
and supervisors who evaluated or supervised your
performance at your last two
employers.
Full name of
reference
School
district/
firm name
Mailing address Position/title
Area code,
phone
number
EMPLOYMENT APPLICATION FOR SUBSTITUTE TEACHER
Verification
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 subsequent
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 authorized by Texas
Education Code §22.083 to obtain criminal
history record information on applicants the district
intends to employ.
______________________________ __________
Signature Date
This application becomes the property of the district. The
district reserves the right to
accept or reject it.