**Applicants must submit a copy of their diploma or transcript before receiving consideration for training.**

Transcription

1 Pg. 1 DEPARTMENT OF PERSONNEL SERVICES Dr. R. Bradley Brown Executive Director of Personnel 711 Green Street, N.W. Gainesville, Georgia Telephone: v Fax: personnel@hallco.org Web-Site: To Recruit and Maintain a Work-Force Supporting the Mission of the Hall County Public Schools APPLICATION FOR SUBSTITUTE TEACHING **Applicants must submit a copy of their diploma or transcript before receiving consideration for training.** PERSONAL INFORMATION Name Last First Middle Preferred Name Date Address Mailing Address City State Zip Code Telephone Number Social Security Number Date of Birth Address (Primary) Person to Contact in Case of Emergency Name Relationship Employer Telephone Number Home Work EDUCATION AND TRAINING High School Name and Address of School Type of Diploma

2 Pg. 2 EDUCATION AND TRAINING (Continued) College Name and Address of Institution Major Type of Degree Date Earned WORK EXPERIENCE List Below ALL Present and Previous Employment -- Beginning with Most Recent. Attach Additional Sheets if necessary. Name of Company Address of Company Dates of Employment From To Telephone Number Name of Supervisor Reason for Leaving Name of Company Address of Company Dates of Employment From To Telephone Number Name of Supervisor Reason for Leaving Name of Company Address of Company Dates of Employment From To Telephone Number Name of Supervisor Reason for Leaving

3 Pg. 3 WORK REFERENCES List Four (4) Work References. Please do not Include Relatives. Name Address Occupation Telephone Number PERSONAL REFERENCES List Three (3) Personal References. Please do not Include Relatives. Name Address Occupation Telephone Number SUBSTITUTE TEACHER APPLICANTS RECOMMENDATION OF PRINCIPAL This section must be signed by a principal in the Hall County School System prior to the applicant attending Substitute Teacher Orientation. As principal of, I RECOMMEND I DO T RECOMMEND as a substitute teacher in the Hall County Public Schools. Signature of Principal Date OTHER INFORMATION Are you a United States citizen or if not, do you have the legal right to work/remain in the United States permanently? Federal immigration laws (Immigration Reform and Control Act of 1986) require employers to verify and attest to the employment eligibility of new employees to work in the United States. This requirement applies to all applicants. Are you legally authorized to work in the United States? Will you now, or in the future, require District sponsorship for employment (e.g. H-1B visa)?

4 Pg. 4 Are you able to perform, with or without reasonable accommodations, the essential functions of the position for which you are applying? PERSONAL AFFIRMATION If you answer "" to any of the following questions, a detailed explanation and supporting documentation, including the date of the charge, the court action, and the address of the court involved, must be attached to this application. Please note that a answer to these questions may not necessarily disqualify you from consideration for employment. Events before the age of 17 may be excluded and need not be reported. Failure to complete ALL of this section will result in the disqualification of your application. Have you ever resigned or been discharged from any position, including the armed forces, while under suspicion of having engaged in criminal, immoral, or unprofessional conduct, or are you now under investigation for any such charge? Has your contract with any school system ever been terminated or non-renewed? Have you ever been investigated for misconduct related to your employment? Have you ever been convicted, pled guilty, or pled nolo contendere to a criminal offense (felony or misdemeanor), or are you now under investigation for any such offense other than a minor traffic violation? For the purpose of this application, Driving/Boating under the Influence (DUI) or Driving/Boating while Intoxicated (DWI) must be reported. Have you ever received probation, deferred judgment, or pre-trial intervention? Have you ever been arrested (even if no contest or charges dropped or pled down) for a crime? Have you ever been charged (even if no contest or charges dropped or pled down) for a crime? Have you ever been convicted (even if no contest or charges dropped or pled down) for a crime? Are you currently under investigation, or been named in an indictment, accusation, or special presentment of any offense, other than a minor traffic violation? Are you under investigation, or have you been charged with any violation of the Code of Ethics for Georgia Educators or any similar professional inquiry in any other state? Have you ever been named by a state agency responsible for child welfare as a perpetrator in an indicated report of child abuse or neglect or have you ever been investigated for a crime of child abuse or physical abuse? Have you ever had a report of child abuse or sexual activities involving a K-12 student or minor filed against you with a school district, a state or federal agency, a police agency, or in court?

5 Pg. 5 Have you ever had a teaching certificate, credential, permit, or license (of any kind) denied, revoked or suspended, or have you been placed on probationary status for any alleged misconduct or alleged violation of professional standards or conduct, or are there any pending investigations or adverse actions against you? PERSONAL AFFIRMATION (Continued) Have you ever surrendered a teaching certificate, credential, permit, or license of any kind before its expiration? Have you ever been granted a professional license on a conditional or probationary basis for any alleged misconduct or alleged violation of professional standards of conduct? Have you ever been disciplined by any public agency responsible for licensure of any kind, including but not limited to educational licensure? Have you ever failed to complete a contract for educational services in any educational or school-related position? Have you ever been placed on leave by your employer or left such employment prior to the end of the contract term? Have you ever been dismissed from employment or had a contract non-renewed? Have you ever resigned in lieu of dismissal, contract non-renewal, or termination of employment? Have you ever been asked to resign in lieu of dismissal, contract non-renewal, or termination of employment? Have you ever received an unsatisfactory performance evaluation? Knowing that false statements made in this application may constitute sufficient grounds to terminate my employment and may constitute grounds for legal action, I affirm that, to the best of my knowledge, all information contained in this application is true and correct. Furthermore, I hereby give permission to the Hall County Board of Education to obtain copies of any criminal, financial, and personal records relating to me (including records which may have been sealed or expunged) which are held by any local, state, or federal governmental agency or private entity, and authorize any such agency or entity to release these records to the school district. I hereby authorize and request any former employer or supervisor to release any information and opinions concerning the performance of my duties, including any evaluation of my performance and the circumstances of my leaving that employment. If this application is for school bus driving, I hereby authorize the Hall County Board of Education to request a copy of my driving record from the Georgia Department of Public Safety. I agree that if any willful or material misrepresentation has been made, any offer of employment may be withdrawn or my employment terminated immediately without obligation or liability to me other than payment for services actually rendered. (For Central Office Use)

6 Pg. 6 Signature Date Applicant Number TICE OF DISCLOSURE: Under Georgia s Open Records Law, all applications and resumes are subject to public disclosure upon receipt by the Board of Education. Pursuant to O.C.G.A , all employees are required by Georgia law to be fingerprinted for a criminal background check through the Georgia Bureau of Investigation and the Federal Bureau of Investigation.