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SUBSTITUTE TEACHER APPLICATION
DATE:_____________________
NAME: ____________________________________________________________________________________
(As it appears on your Social Security Card)
ADDRESS:
________________________________________________________________________________
_______________________________________________________ Zip___________________
TELEPHONE:
______________________
EMAIL ADDRESS:
SOCIAL SECURITY #:
______________________________
_________________________________________________________________________
PLEASE SPECIFY THE FOLLOWING:
Days Available:
Grades/Subjects Preferred:
Schools Preferred:
M
________________________
Tu
W
Th
F
__________________________________
EDUCATION:
HIGH SCHOOL: ______________________________________
YEAR GRADUATED:______________________
COLLEGE/UNIVERSITY: ______________________________
YEAR GRADUATED:_______________________
COLLEGE MAJOR:____________________________________________________________________________
CERTIFICATION/LICENSE:
TEACHER CERTIFICATE NUMBER:
___________________________ EXPIRES:
_______________________
CERTIFICATION AREA: ______________________________________________________________________
SUBSTITUTE LICENSE:
YES ______
NO
_______
EXPIRES:__________________________________
YEARS TEACHING EXPERIENCE: ________________ YEARS SUBSTITUTE TEACHING EXPERIENCE: ________
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WORK EXPERIENCE:
Employer Name and Telephone Number
Date of Employment
Job Title
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________
PERSONAL REFERENCES:
Name and Address
Telephone Number
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________
Have you ever been convicted of or entered a plea of no contest to a felony or misdemeanor
other than a minor traffic violation?__________ YES__________NO
If you answer “ YES, ” please provide details of conviction including date and place of
conviction and submit court certified copies of the judgement, conviction, and sentencing.
I hereby certify that all the information I have provided in this application is true and
correct.
I give my permission for the Mountain Brook City Schools to contact any
references or prior employers given in conjunction with this application. I agree that
falsification of any part of this application may be sufficient cause for dismissal.
References and personal information which become a part of this application will be
regarded as confidential and shall not be revealed to me.
Signature of Applicant: ________________________________
Date:
______________________
It is the official policy of the Mountain Brook Board of Education, including any schools and programs under its
control, that no person shall, on the grounds of race, color, disability, sex, religion, national origin, or
age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any
program, activity, or employment.
Complete the form above, then print the completed form.
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