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Substitute Application

SUBSTITUTE APPLICATION

BON HOMME SCHOOL DISTRICT #04-2

District Office, PO Box 28, 1404 Fir Street, Tyndall, SD 57066

 

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

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

 

Bon Homme School District is an equal opportunity employer. The Bon Homme School District does not discriminate against any employee on the basis of sex, race, religion, national origin, age, height, weight, marital status, or handicap/disability unrelated to the employee's ability to perform his/her job.

 

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  

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