IMPORTANT INFORMATION REGARDING APPLICATIONS TO: FROM: SUBJECT: DATE: Karen Makin, IU 8 Program Coordinator Application for Substitute Teacher Program Thank you for your interest in the IU 8 Substitute Teacher Program. Enclosed you will find an application for the program as well as a brochure detailing program requirements and details. Upon the approval of a completed application you will receive the additional paperwork described in the brochure. Please note that trainings are only held when we have ten people. You are encouraged to have your application in as soon as possible so it may be reviewed and you can be considered for the training list. Items that are to accompany your application: PAE # for act 114 (FBI clearance) {obtained after registering for fingerprinting on Cogent Website} [clearance is processed within 24 hours of being fingerprinted] 3 current letters of professional references (from individuals that will have first hand knowledge of your character, personality, scholarship and ability) individuals writing reference letters may forward them directly to my office reference letters must be less than 1 year old original act 34 clearance (criminal record check)* original act 151 clearance (child abuse history check)* completion of PDE 6004 form completion of the written interview/screening form * Act 34 and Act 151 clearance applications are available from the IU 8 website (www.iu08.org) or by contacting my office original clearances will be returned after inspection. We prefer clearances to accompany the application, however if you do not have current clearances they may be forwarded once you receive them. Clearances generally take at least 3 weeks to process. Official transcripts indicating a bachelor s degree (in a sealed envelope from the college) may be sent with the application or forwarded directly from your college or university. Only transcripts indicating a bachelor s degree are necessary for processing an emergency certificate. If you have any questions regarding the paperwork required please contact me at 940-0223 ext. 1316 or email kmakin@iu08.org. Thank you for your cooperation and interest in becoming a substitute teacher. Enclosures
Appalachia Intermediate Unit 8 Substitute Teacher Program Preference Information 4500 Sixth Avenue, Altoona, PA 16602 814-940-0223 (Please Type or Print) Name: Last First Middle Phone #: ( ) Social Security #: Email Address: 1. The following are districts participating in the IU 8 Substitute Teacher Program. Please indicate with an x any of the school districts in which you are willing and available to substitute: Cambria County: Blacklick Valley Cambria Heights Conemaugh Valley Ferndale Area Forest Hills Greater Johnstown Penn Cambria Portage Area Richland Westmont Hilltop Appalachia IU 8* Admiral Peary AVTS Blair County: Spring Cove Tyrone Area Williamsburg Community Appalachia IU 8* Hollidaysburg Area Bedford County: Bedford Area Appalachia IU 8* Chestnut Ridge Everett Area Northern Bedford County Tussey Mountain Somerset County: Berlin Brothervalley Conemaugh Township North Star Shade Central City Shanksville-Stonycreek Windber Area Appalachia IU 8* * Appalachia IU 8 has classes in districts within Blair, Bedford, Cambria and Somerset Counties. IU 8 classes are comprised of special needs children.
Appalachia Intermediate Unit 8 will forward your application to the district(s) you selected above. Applicant files are not sent until all paperwork and training is completed. 2. Please indicate with an x any of the level(s) you prefer: Elementary Junior High Middle Senior High Note the permit you will receive will be for all subject areas K-12 so you may be called for all areas but may indicate a preference. 3. Is your availability limited? If so, please list. (Example: need a day s notice, only afternoons, no Wednesdays, etc.) 4. Do you currently hold a Pennsylvania Teaching Certificate? If so, in what areas: 5. Any special skills or licenses? (Trade Skills, Sign-Language, speak a foreign language, nursing, computer skills, etc.) 6. Any other comments: 7. Are you a past participant of the Emergency Sub Program? If yes, approximately when: All applicants must notify IU 8 in writing of any changes in address, phone number, availability or change in district selection
Appalachia Intermediate Unit 8 Substitute Teacher Program - Preference Update Information 4500 Sixth Avenue, Altoona, PA 16602 814-940-0223 The following are districts in the IU 8 area that have not joined the substitute teacher consortium as of. We are trying to determine candidate interest now so if a district adds it will save time getting applicants to the district(s). Please indicate with an x any of the school districts in which you are willing and available to substitute. You will be contacted if any of the districts selected below are added to the consortium. Cambria County: Central Cambria Greater Johnstown CTC Northern Cambria Blair County: Altoona Area Bellwood-Antis Claysburg-Kimmel Greater Altoona Area AVTS Somerset County: Rockwood Area Meyersdale Area Salisbury-Elk Lick Somerset Area Turkeyfoot Valley Somerset County AVTS Bedford County: Bedford Co. AVTS Please check one: Please update my file to include the district(s) I have indicated above: I do not wish to include any of the above district(s) listed above: Signature: Date: Please return to: Karen Makin, Coordinator of Programs & Support Services, at the address above
Appalachia Intermediate Unit 8 Employment Application for the Substitute Teacher Program 4500 Sixth Avenue, Altoona, PA 16602 814-940-0223 (Please Type or Print) Date available for employment: Name: Last First Middle Address: Social Security #: Street Town State/Zip Code County Home Phone #: ( ) Business Phone #: ( ) High School Educational Background School or institution name Major / Minor Diplomas, Degrees or and address Credits Earned / Grade Point Average (GPA) College / University College / University Graduate Other Certification (if applicable): IU 8 Office Use Only: Act 34 Clearance Credentials PDE 6004 Act 151 Clearance Physical / TB I- 9 Reference Letters FBI Other Training Date: Date Sent to District(s):
Work Experience List in chronological order starting with the most recent Employer Name, Employment Dates Title / Position Reason for Address, and Phone # Description Leaving From: To: From: To: From: To: References Please provide four references including at least one professional reference. A professional reference should be someone who will have first hand knowledge of your character, personality, scholarship and ability. Additionally, you must provide three written current letters of reference from those individuals that you list below as references. Reference letters must be less than one year old. Name and Position Complete Address Phone Number Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experiences (including US Military Service) and/or any additional information you feel may be helpful in considering your application, i.e. honors, awards, activities or professional development activities.
General Background You must give complete answers to all questions. If you answer Yes to any question, you must list all offenses, and for each conviction provide date of conviction and disposition, regardless of the date or location of occurrence. Conviction of a criminal offense is not a bar to employment in all cases. Each case is considered on its merits. Your answers will be verified with appropriate records. Criminal Offense includes felonies, misdemeanors, summary offenses and convictions resulting from a plea of nolo contendere (no contest). Conviction is an adjudication of guilt and includes determinations before a court, a district justice or a magistrate which results in a fine, sentence or probation. You may omit: minor traffic violations, offenses committed before your 18 th birthday which were adjudicated in juvenile court or under a Youth Offender Law, and any convictions which have been expunged by a court or for which you successfully completed an Accelerated Rehabilitative Disposition program. Were you ever convicted of a criminal offense? Are you currently under charges for a criminal offense? Have you ever forfeited bond or collateral in connection with a criminal offense? Within the last ten years, have you been fired from any job for any reason? Within the last ten years, have you quit a job after being notified that you would be fired? Have you ever been professionally disciplined in any state? Are you subject to any visa or immigration status which would prevent lawful employment? Note : If you answered Yes to any of the above questions, please provide a detailed explanation on a separate sheet of paper, including dates, and attach it to this application. Please print and sign your name on the sheet, and include your social security number. Have you ever contributed to or participated in the Pennsylvania Public School Employee Retirement System? Have you been a resident of Pennsylvania 2 years prior to the date of this application?
In your own words, please answer the following question: Essay Why do you wish to be admitted to the Appalachia Intermediate Unit 8 Substitute Teacher Program? Certification and Authorization I certify that all of the statements made by me are true, complete and correct to the best of my knowledge and belief, and are made in good faith. I understand that any misrepresentation of information shall be sufficient cause for: (1) rejecting my candidacy, (2) withdrawing of any offer of employment, or (3) terminating my employment. I hereby authorize all previous employers and/or supervisors to release any and all of my personnel records; and to respond fully and completely to all questions that officials, of Appalachia Intermediate Unit 8 or the participating districts for the Substitute Teacher Program, may ask regarding my prior work history and performance. I will hold such previous employers and/or supervisors harmless of any and all claims that I might otherwise have against them with regard to statements made to this Intermediate Unit. I further authorize these officials to investigate my background. However, I do not waive any rights, which I may have under state or federal law related to my right to challenge the disclosure of unlawful or inaccurate information. Additionally, I authorize Appalachia Intermediate Unit 8 to release any and all employment information to the participating districts of the Substitute Teacher Program. Signature: Date: Pennsylvania School Districts and Intermediate Units do not discriminate in their educational programs, activities or employment based on race, color, national origin, sex, disability, age, religion, ancestry or any other legally protected classification. This policy is in accordance with state and federal laws, including Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Sections 503 and 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and the Americans with Disabilities Act of 1990.
Appalachia Intermediate Unit 8 Substitute Teacher Program Written Interview Please complete this information and forward with your application. Candidates Name: Date: 1. How did you become interested in being a substitute teacher? 2. What is your greatest strength? 3. What is your greatest weakness? 4. What kinds of things bother you most? 5. What are your professional goals for next year and the next five years? 6. How would you deal with uncooperative students? Uncooperative co-workers? 7. Are you more comfortable working with certain grade levels or subject areas or with a specific disability? 8. Is there any grade level, subject area or disability that you are not willing to teach? 9. Do you have any other skills that can be useful in the classroom?
Appalachia Intermediate Unit 8 Emergency Substitute Teacher Program Applicant Acknowledgement of Arrests and/or Incidents for Permit Processing Please read the following information carefully and complete the sign off information that follows: Intermediate Unit 8 processes permits for eligible candidates via the PA Department of Education on-line upload system. Please be advised that not all applicants can be processed through IU 8 and require the PA Department of Education to process. Any individual who has had an arrest at anytime or any incident reported on one of the three clearances may prohibit IU 8 from processing the permit. If you are in this situation you will be required to submit your paperwork to IU 8 and we will then apply for the permit through the PDE send in process. This process can take PDE 3-6 months for review especially if this is your first emergency permit. Any PDE send in application will require a $5 money order (payable to the Commonwealth of Pennsylvania), signed letter of explanation of the incident, certified court documents related to all criminal matters, your resume, a current FBI clearance, a current original PA Criminal Background Check, current original PA Child Abuse Clearance, five letters of references (at least three must be professional references), and a letter from your probation officer if applicable. All relative information must be submitted with the application. Please be advised that any candidate that fails to communicate an arrest or record and it appears on a clearance will be immediately removed from the program. You should also understand that under certain circumstances an arrest or incident can be removed from a clearance for example an individual may complete an ARD program which in turn may remove a DUI from a record. Even if these arrests/instances are removed from your record you are still required to communicate this with IU 8. IU 8 will determine if it is necessary for your application to be sent in to the PA Department of Education for processing. The PDE 338G form that you will complete is considered a legal document and failure to communicate arrests or incidents could result in legal action as determined by the PA Department of Education. If you have a record or have charges pending you must answer yes to the specific question on the form PDE 338G. Issuance of the permit is at the discretion of the PA Department of Education. Once a candidate with a record receives a permit, which would expire at the end of the school year, the same application process will most likely need to be followed for subsequent renewals. In some cases PDE will allow renewals to be processed by IU 8. Subsequent renewals will still take time for processing but typically the time frame is shorter than the first permit. Candidates should also be advised the PDE 338 G form which you will complete each year for issuance of the permit is considered a legal document according to the PA Department of Education. Any individual who may receive an arrest or incident after the receipt of a permit is required to communicate the information to IU 8. Any such arrest/incident will be forwarded to the districts that you have selected to sub for. The district may remove you from their sub list and removal from the program is also possible. A past conviction or arrest may or may not be prohibitive with respect to the issuance of an emergency permit by PDE. However, at the sole discretion of a school district, persons with such records may not be hired. Please complete the following I have no arrests or incidents that have been removed from my records and/or clearances I have an arrest or incident that will appear on my record and/or clearance please submit a signed letter of explanation indicating information related to the arrest/incident. I have charges pending against me that may or may not appear on my clearance - this includes charges that have not received an outcome as of the date of signing this document please submit a signed letter of explanation indicating information related to the arrest/incident. By signing below you acknowledge that you have communicated any and all arrests or incidents to IU 8 and that failure to communicate an arrest or incident the permit may be revoked by the PA Department of Education and they may consider legal action for failure to communicate such arrests/incidents. My signature below indicates I have read and understand the information above. Name of candidate SS # Signature Date
1 of 3 ARREST/CONVICTION REPORT AND CERTIFICATION FORM (under Act 24 of 2011 and Act 82 of 2012) Section 1. Personal Information Full Legal Name: Any former names by which you have been identified: Date of Birth: / / Section 2. Report of Arrest or Conviction By checking this box, I report that I have been arrested for or convicted of an offense or offenses enumerated under 24 P.S. 1-111(e) or (f.1) ( Reportable Offense(s) ). See Instructions on Page 3 of this Form for a list of Reportable Offenses. If you have none to report, proceed to Section 3 of this form. Details of Arrests or Convictions For each arrest for or conviction of any Reportable Offense, specify in the space below (or on additional attachments if necessary) the offense for which you have been arrested or convicted, the date and location of arrest and/or conviction, docket number, and the applicable court. Section 3. No Arrest or Conviction By checking this box, I state that I have not been arrested for or convicted of any Reportable Offense. Section 4. Certification By signing this form, I certify under penalty of law that the statements made in this form are true, correct and complete. I understand that false statements herein, including, without limitation, any failure to accurately report any arrest or conviction for a Reportable Offense, shall subject me to criminal prosecution under 18 Pa.C.S. 4904, relating to unsworn falsification to authorities. Signature Date PDE-6004 (8/28/2012)
2 of 3 INSTRUCTIONS This standardized form (PDE-6004) has been developed by the Pennsylvania Department of Education, pursuant to 24 P.S. 1-111(j), to be used by current and prospective employees of public and private schools, intermediate units and area vocational-technical schools for the written reporting by current and prospective employees of any arrest or conviction for an offense enumerated under 24 P.S. 1-111(e) and (f.1). As required by subsection (j)(2) of 24 P.S. 1-111, this form shall be completed and submitted by all current and prospective employees of a public or private school, intermediate unit or area vocational-technical school. In addition, as required by subsection (j)(4) of 24 P.S. 1-111, this form shall be utilized by current and prospective employees to provide written notice within seventy-two (72) hours after an arrest or conviction for an offense enumerated under 24 P.S. 1-111(e) or (f.1). Exemption: Any current employee who completed a PDE-6004 on or before December 27, 2011, in compliance with 24 P.S. 1-111(j)(1) and (2) on that date, and who has not been arrested for or convicted of an offense enumerated under 24 P.S. 1-111(e) and (f.1) shall not be required to complete an additional form. In accordance with 24 P.S. 1-111, employees completing this form are required to submit the form to the administrator or other person responsible for employment decisions in a school entity. If you have questions regarding to whom the form should be sent, please contact your supervisor or the school entity administration office. PROVIDE ALL INFORMATION REQUIRED BY THIS FORM LEGIBLY IN INK. PDE-6004 (8/28/2012)
3 of 3 LIST OF REPORTABLE OFFENSES A reportable offense enumerated under 24 P.S. 1-111(e) consists of any of the following: (1) An offense under one or more of the following provisions of Title 18 of the Pennsylvania Consolidated Statutes: Chapter 25 (relating to criminal homicide) Section 2702 (relating to aggravated assault) Section 2709.1 (relating to stalking) Section 2901 (relating to kidnapping) Section 2902 (relating to unlawful restraint) Section 2910 (relating to luring a child into a motor vehicle or structure) Section 3121 (relating to rape) Section 3122.1 (relating to statutory sexual assault) Section 3123 (relating to involuntary deviate sexual intercourse) Section 3124.1 (relating to sexual assault) Section 3124.2 (relating to institutional sexual assault) Section 3125( relating to aggravated indecent assault) Section 3126 (relating to indecent assault) Section 3127 (relating to indecent exposure) Section 3129 (relating to sexual intercourse with animal) Section 4302 (relating to incest) Section 4303 (relating to concealing death of child) Section 4304 (relating to endangering welfare of children) Section 4305 (relating to dealing in infant children) A felony offense under section 5902(b) (relating to prostitution and related offenses) Section 5903(c) or (d) (relating to obscene and other sexual materials and performances) Section 6301(a)(1) (relating to corruption of minors) Section 6312 (relating to sexual abuse of children) Section 6318 (relating to unlawful contact with minor) Section 6319 (relating to solicitation of minors to traffic drugs) Section 6320 (relating to sexual exploitation of children) (2) An offense designated as a felony under the act of April 14, 1972 (P.L. 233, No. 64), known as The Controlled Substance, Drug, Device and Cosmetic Act. (3) An offense SIMILAR IN NATURE to those crimes listed above in clauses (1) and (2) under the laws or former laws of: the United States; or one of its territories or possessions; or another state; or the District of Columbia; or the Commonwealth of Puerto Rico; or a foreign nation; or under a former law of this Commonwealth. A reportable offense enumerated under 24 P.S. 1-111(f.1) consists of any of the following: (1) An offense graded as a felony offense of the first, second or third degree, other than one of the offenses enumerated under 24 P.S. 1-111(e), if less than (10) ten years has elapsed from the date of expiration of the sentence for the offense. (2) An offense graded as a misdemeanor of the first degree, other than one of the offenses enumerated under 24 P.S. 1-111(e), if less than (5) five years has elapsed from the date of expiration of the sentence for the offense. (3) An offense under 75 Pa.C.S. 3802(a), (b), (c) or (d)(relating to driving under influence of alcohol or controlled substance) graded as a misdemeanor of the first degree under 75 Pa.C.S. 3803 (relating to grading), if the person has been previously convicted of such an offense and less than (3) three years has elapsed from the date of expiration of the sentence for the most recent offense. PDE-6004 (8/28/2012)