Employment Application For A Certificated Substitute Service Position

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Personal Information
Name Last* First* Middle (Any other name which employed)

Social Security Number*: Telephone*:

E-mail Address:
If you enter a valid email address, upon successful submission of this on-line application form, a confirmation message will be sent to that email address.

Addresss No./Street* City* State* Zip*

Professional Informationn Credential(s) held:
  Type: Date of Expiration Date of Application
1.
2.
Foreign Language Ability: Spanish Other: Level:

Educational and Professional Preparation
  Colleges/Universities Attended From(Date) To(Date) Subject/Major Graduation Date Degree
1.
2.
3.
4.

Occupational Experience Related To Educational Field (most recent first)
  School/District Address From(Date) To(Date) Grades/Subjects
1.
2.
3.

Experience Other Than Teaching (Most recent first)  
  Firm City/State Type of Work From(Date) To(Date)
1.
2.
3.
4.

Questions Answers will not necessarily disqualify you from consideration, but may be discussed with you by a personnel administrator.

If needed - Reference explanation to below items in the box below. Reference by number 1, 2, 3, etc.

1.* Have you ever had a credential suspended or revoked?
If yes, please explain where and why.
Yes No
2.* Have you ever been convicted by any court of any crime?
If yes, give date, place, offense, and fine or sentence in each instance.
(Do not list any juvenile offenses)
Yes No
3.* Have you ever been dismissed or asked to resign from a job?
If yes, give name of employer and explain situation.
Yes No
4.* Have you ever left a teaching position prior to contractual agreement?
If yes, please explain where and why.
Yes No
5.* Have you ever been employed by this district?
If yes, give location, dates, and classification below.
Yes No
6.* Are you a U.S. Citizen?
If no, give type of VISA.
Yes No
Explanations for above answers:

References
  Name Occupation Address: Phone Day/Night
1.
2.
3.

Certification Of Application
  1. 1. The information that I have provided on this Certificate Applicant Profile is accurate to the best of my knowledge and subject to validation by the Newport-Mesa Unified School District.

  2. Any material misrepresentation or deliberate omission of fact in my application may be justification for refusal of, or if employed, termination from the Newport-Mesa Unified School District.

  3. All substitute applications are kept on file by the Newport-Mesa Unified School District until June of the current school year. I understand that if I am not a current substitute for Newport-Mesa and I am interested in a substitute position with the District for the next school year, I will need to resubmit another application packet.
     

Legal Name*:

The Newport-Mesa Unified School District does not discriminate on the basis of sex, race, color, religious creed, national origin, ancestry, physical handicap, medical condition or age in its employment practices.