Name ______________________________                 ______________________________            _____

                Last                                                                        First                                                                        M.I. 

 

Social Security Number: _____ - _____ - _____   Name as it is on Card: _____________________________________________

 

Substitute Position(s) for which you are applying: (Teacher, Paraprofessional, Custodian) ___________________________________

 

Present Address: ______________________________   City ____________________ State _________ ZIP ______________

Home Telephone (____) _______________ Cell Phone (____) _______________ Best time to call __________

Email Address ____________________________________________

 

Place of Employment: ______________________________________________ May we contact you at work? _____ Yes _____ No

Work Telephone (____) _______________ Best time to call __________

 

Which school(s) would you wish to be listed as a substitute?  (Check any that apply)

_____ Bon Homme Hutterische Colony (K-8)

_____ Dawson Colony (K-8)

_____ Springfield Elementary (K-5)

_____ Tabor Elementary (K-5)

_____ Tyndall Elementary (PK-5)

_____ Bon Homme Middle School (6-8)

_____ Bon Homme High School (9-12)

High School subjects for which you do NOT wish to sub:  ___________________________________

Education Level (Please check one)

_____ High School

_____ Bachelor’s Degree (not in education)

_____ Other ___________________________________

Please forward a copy of your diploma or transcript showing graduation from your highest level of education to the District Office.

 

_____ Bachelor’s Degree in Education

                Do you have a valid teaching certificate? ____yes

                                Teaching Certificate:  Number____________________            Expiration Date_______________

                Do you have an expired teaching certificate? ____ yes

                                Teaching Certificate:  Number_______________       Expiration Date_______________

Please forward a copy of your teaching certificate (expired or valid) to the District Office.

Have you been convicted of a CRIME in the last 7 years? _____Yes _____No (Conviction may be relevant if job related but does not necessarily bar you from employment).  If yes, please explain: ________________________________________________________

__________________________________________________________________________________________________________

 

Have you had a DCI/FBI background check with another school district? _____

If yes, which district(s)? _______________________________________________________________________________________

 

Do you have any past or current physical or mental health conditions which may affect the performance of your work? 

_____Yes _____No    If yes, please explain:

Physical Health ______________________________________________________________________________________________

Mental Health _______________________________________________________________________________________________

 

Are you a US citizen? _____Yes _____No                   If no, do you have a Green Card? _____Yes _____No

List information regarding your interests, abilities, activities, and experience which you feel has a bearing on your qualifications for this position.

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

EDUCATION

Name & Location                   From - To                                Degree(s)                                Date Received

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

EDUCATION REFERENCES

Full Name                               Title                             Complete Address                              Telephone

_________________________________________________________________________________________

_________________________________________________________________________________________

WORK EXPERIENCE

Begin with most recent job. Do not include part-time or summer work unless you consider it significant.

Name & Location                   From - To                    Nature of Work                                   Supervisor

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

EMPLOYMENT REFERENCES

List information for those supervisors listed above in Work Experience.

Full Name                               Title                             Address, City, State, ZIP                                Telephone

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

I verify that the information given by me in this application is true, accurate, and complete. I understand that if I have given any false information on this application or if I have omitted any material fact, I may be disqualified from employment with Bon Homme School District, or if hired, I may be discharged upon discovery of such false statement(s) or omission(s). I understand that my employment with Bon Homme School District may be subject to a reference/background check. I hereby authorize Bon Homme School District to investigate the truthfulness of all statements made on this application and/or contact my former employer(s) and other listed reference(s) or any other person(s) who can verify any information submitted to Bon Homme School District in support of my application for employment. I hereby waive any right that I may have against any person contact by Bon Homme School District, including former employers who provide information concerning this application and I release each said person from liability for providing information. 

 

 

 

______________________________________________                ____________________

Signature                                                                                             Date