Substitute Teacher Application 30 college hours required. Pay rate $95 per day Substitute Teacher Application PERSONAL INFORMATION Name Name First First Middle Middle Last Last Address Telephone no. City State ZIP Email Are you legally eligible to work in the United States? (Federal Law requires proof of identity and employment authorization for all new employees.) Yes No Can you travel if the job requires it? Yes No Do you have a valid driver’s license? Yes No State EDUCATION/TRAINING High School Information Name (High School) Location (High School) Date attended from (High School) Date attended to (High School) Graduated? Yes No College Information Name (College) Location (College) Date attended from (College) Date attended to (College) Graduated? Yes No Other (Business, Vocational, Military) Name (Business, Vocational, Military) Location (Business, Vocational, Military)) Date attended from (Others) Date attended to (Others) Graduated? Yes No EMPLOYMENT HISTORY (Please Start With the Most Recent) Employer-1 Address (Emp-1) Telephone no (Emp-1) Supervisor Name Date From Date To Final rate of pay Position held (Emp-1) Primary duties (Emp-1) Reason of leaving (Emp-1) Next Employer (Emp-2) Employer-2 Address (Emp-2) Telephone no (Emp-2) Supervisor Name (Emp-2) Date From (Emp-2) Date to (Emp-2) Final rate of pay (Emp-2) Position held (Emp-2) Primary duties (Emp-2) Reason of leaving (Emp-2) Next Employer (Emp-3) Employer-3 Address (Emp-3) Telephone no (Emp-3) Supervisor Name (Emp-3) Date From (Emp-3) Date to (Emp-3) Final rate of pay (Emp-3) Position held (Emp-3) Primary duties (Emp-3) Reason of leaving (Emp-3) TECHNOLOGY SKILLS (List All Skills & Software Applications You Have Experience Using): Word processing: Yes No Spreadsheet: Yes No Database: Yes No Microsoft Office: Yes No PowerPoint: Yes No Scanner: Yes No Copier: Yes No Digital Phone Systems: Yes No Explain Internet Skills, Including Email Usage: Describe your other software/technology skills (if any): Professional Licenses or Certificates Held: PERSONAL REFERENCES (Please list the names of three (3) persons not related to you by blood or marriage.) Name (Ref-1) Name (Ref-1) First First Middle Middle Last Last Address (Ref-1) Telephone (Home) Telephone (Others) Connection To You (i.e. friend, co-worker): Occupation (Ref-1): Personal Reference (Ref-2) Name (Ref-2) Name (Ref-2) First First Middle Middle Last Last Address (Ref-2) Telephone (Home) Telephone (Others) Connection To You (i.e. friend, co-worker): Occupation (Ref-2): Personal Reference (Ref-3) Name (Ref-3) Name (Ref-3) First First Middle Middle Last Last Address (Ref-3) Telephone (Home) Telephone (Others) Connection To You (i.e. friend, co-worker): Occupation (Ref-3): OTHER DETAILS If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? Yes No Have you ever been arrested or convicted of a criminal offense (felony or misdemeanor)? Yes No If yes, please describe the criminal offense and the court’s disposition: (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.) Acknowledgement – Please read before signing A photocopy of official transcripts of all college/university course work must be filed in Human Resources with theapplication. At the time of hire, official, original transcripts will be required.A Criminal History Check form must be completed with the online application.At the time of hire, a copy of driver's license and Social Security card must be filed for payroll purposes only.An Employment Eligibility Verification (Form I-9) must be completed at the time of hire (Original documents only).In order to receive credit for prior years of service, the applicant must obtain official service records from each school district where previously employed.Professionals recommended for employment after January 1, 2008 will be required to submit to a national fingerprint criminal background check. The applicant is responsible for fees of approximately $50. Applicant will not begin work until fingerprints have been cleared. On the first day of employment, I agree to furnish Instant Impact Global Prep with proof of age, appropriate academic credentials, military separation papers, professional certifications, and other such documents as may be required. I hereby authorize Instant Impact Global Prep and/or its designee’s permission and authority to conduct a background investigation and reference checks concerning my past and current activities. I agree and consent to any investigation Instant Impact Global Prep and/or its designees may make, including but not limited to, information as to my personal character, generalreputation, former employment, education, criminal history, and any other information contained in public records or obtainable from former employers or references, personal or business. Date Upload your signature Drop your signature to upload Choose File Maximum upload size: 5MB Supported file type: jpg, jpeg, jpe, png, gif Social Security Number: Date of Birth: File Attachment Drop a file here or click to upload Choose File Maximum upload size: 15MB If you are human, leave this field blank. Submit Δ
