1 TO THE SUBSTITUTE TEACHER APPLICANT - Douglas County ...

TO THE SUBSTITUTE TEACHER APPLICANT:Thank you for your interest in substitute teaching for Douglas County School District. In order tofacilitate the processing of your application, we ask that the instructions below be carefully read andfollowed. We will send you notification of receipt of your application.Please submit your application by mailing the following information to: Douglas County SchoolDistrict Substitute Office, 620 Wilcox Street, Castle Rock, CO, 80104. Attached “Certified/Licensed Substitute Application” (completed and signed) Attached signed “References” page with employment references (addresses and faxnumbers must be complete and current). If you have not been employed recently, youmay list a supervisor from volunteer work. Please be sure your references areexpecting the questionnaire. If you are using retired individuals, you need to put theirhome address, not where they were employed. Attached completed and signed Background Information Form. Three letters of reference (may be from the same people as those listed on referencessheet but need to be current within the last year) A current resume (including education level and past work experience, including anywork with children) A copy of your valid Colorado Teaching License ( Professional, Initial, Interim) orSubstitute Authorization (Three or Five Year)The application process usually takes approximately two months. Please do not call about yourapplication status. You will be notified within two months, pending completion of the process.Those applicants, who are qualified, will be invited to join our Substitute Teacher program and willbe required to attend substitute orientation. You are scheduled for orientation according to thereceived date on your application (usually two months after). Orientations for the 2006-2007 schoolyear will begin in late August of 2006. You will receive a letter containing the orientationinformation.If you have any questions about the application process, please call:(303) 387-0183, (303) 387-0184 or (303) 387-01801st Year Rates of Pay ( 2 nd year and long term rates are higher and given out at orientation):Days per school year: 1-60 days 61-90 days 91-189 daysPaid per full day: $80 $90 $130Paid per half day: $45 $50 $701

Douglas County School DistrictCERTIFIED/LICENSED SUBSTITUTE APPLICATIONPLEASE REMEMBER TO: Complete ALL PAGES of this application. Answer ALL questions. PRINT legibly.FAILURE TO FOLLOW PROCEDURE COULD RESULT IN DENIAL OF APPLICATIONSocial Security Number - - E-mail:Name:Mailing Address:City/State/Zip:Telephone No.:Other No.:License Type:Expiration Date:(Example: Professional Teacher, Substitute Authorization, etc.)CO License: (Level)(Example: K-6, Secondary, etc.)Major/Minor Areas of Study at College/Tech School:Subject/Specialty:(Example: Elem.Ed., P.E., Math, etc.)Yes No1. Are you able to perform the job-related functions of the position(s) for which you are applying? ___ ___2. Have you ever been convicted of a felony or misdemeanor? ___ ___3. Has any court ever received a plea of guilty or a plea of nolo contends ere from you for any offense;deferred further proceedings without entering a finding of guilty and place you on probation? ___ ___4. Have you ever been convicted of, pled nolo contend ere to, or received a deferred sentence for acrime involving unlawful sexual behavior involving a child?If yes, please explain:5. Have you ever been dismissed, or have you resigned from a position as a result of an allegation ofunlawful behavior involving a child, including unlawful sexual behavior?If yes, please explain:6. Have you ever been involuntarily terminated from any employment?If yes, please explain:7. Has your teaching certificate ever been annulled, suspended or revoked?If yes, please explain:___ ______ ______ ______ ___8. Have you substituted in Douglas County Schools before? If yes, dates? ___ ___9. Were you employed in this District before? If yes, dates and job title? ___ ___Signature of Applicant:2Date:

CURRICULUM CHOICES___________________________________________________________________________Elementary Licensed Experienced No Experience Comment(or Degree) (Work/Sub) but will try_____________________________________________________________________Art _________ _________ _________ _________Regular Classroom _________ _________ _________ _________(Note grade level preferences if different from K through 6)Music (General/Vocal) _________ _________ _________ _________Music (Instrumental) _________ _________ _________ _________(For general, vocal or instrumental, please note the instrument that you play, if any)Literacy _________ _________ _________ _________Physical Education _________ _________ _________ _________Preschool _________ _________ _________ _________ESL _________ _________ _________ _________(English as a Second Language)( You do not need to know a second language to work with ESL)Technology (Computer) _________ _________ _________ _________Secondary Licensed Experienced No Experience CommentACE/Alternative _________ _________ _________ _________Art _________ _________ _________ _________Business _________ _________ _________ _________Drama/Speech _________ _________ _________ _________English/Language Arts _________ _________ _________ _________ESL _________ _________ _________ _________(English as a Second Language)(You do not need to know a second language to work with ESL)Foreign Language _________ _________ _________ _________(Note which Foreign language(s) you speak)Health _________ _________ _________ _________Consumer/Family Studies_________ _________ _________ _________Industrial Arts/Agriculture_________ _________ _________ _________Literacy _________ _________ _________ _________Math _________ _________ _________ _________Media (Library) _________ _________ _________ _________Music (General/Vocal) _________ _________ _________ _________Music (Instrumental) _________ _________ _________ _________(For general, vocal, or instrumental, please note the instrument you play, if any)Physical Education _________ _________ _________ _________Science _________ _________ _________ _________(Note which science you have experience with or prefer)Social Studies _________ _________ _________ _________Technology (Computer) _________ _________ _________ _________STAR Lab (Computer) _________ _________ _________ ______________________________________________________________________________Special Education _________ _________ _________ _________3

REFERENCELegislation passed in the State of Colorado requires that we contact a previous employer toobtain information before we employ any person to work in a school district in this state.Therefore, you must list previous employers on this form. If you have more than two referencesyou would like to list, they have to be listed on this form and signed by you. We are required, bythe same law, to keep confidential any information we obtain from previous employers becauseof this process.Please PRINT COMPLETE ADDRESS information. If complete address information ismissing, it will prevent us from processing your application.Supervisor Name and Position_______________________________________________Organization_____________________________________________________________Street No./P.O. Box_______________________________________________________City/State/Zip____________________________________________________________Fax Number:_____________________________________________________________I hereby authorize any individual, company, or institution with whom I have been associated tofurnish the Douglas County School District with any information concerning my employment.Signature of Applicant:_______________________________ Date:________________REFERENCELegislation passed in the State of Colorado requires that we contact a previous employer toobtain information before we employ any person to work in a school district in this state.Therefore, you must list previous employers on this form. If you have more than two referencesyou would like to list, they have to be listed on this form and signed by you. We are required, bythe same law, to keep confidential any information we obtain from previous employers becauseof this process.Please PRINT COMPLETE ADDRESS information. If complete address information ismissing, it will prevent us from processing your application.Supervisor Name and Position_______________________________________________Organization_____________________________________________________________Street No./P.O. Box_______________________________________________________City/State/Zip____________________________________________________________Fax Number:___________________________________________________I hereby authorize any individual, company, or institution with whom I have been associated tofurnish the Douglas County School District with any information concerning my employment.Signature of Applicant:_______________________________ Date:________________4

Douglas County School District Re. 1620 Wilcox St.Castle Rock, CO 80104Background InformationNotification FormThe purpose of this form is to notify you that a consumer report (i.e. background check) will be runon you in the course of consideration for substitute teaching with:Company Name: Douglas County School DistrictPlease Print or TypeLast Name First __Middle________________Social Security # Date of Birth _________Age ______Driver’s License Number State of Issue ____________Present Address____________In connection with this request, I authorize all corporations, former employers, educationalinstitutions, law enforcement agencies, city, state, county and federal courts, military servicesand persons to release information they may have about me to the person or company with whichthis form has been filed, or their agent, Douglas County School District. This releases theaforesaid parties from any liability and responsibility for collecting the above information.I also authorize a consumer report to be run. I understand that these files may contain negativeinformation about my background, mode of living, character, and personal reputation. Thisauthorization, in original or copy form, shall be valid for this and any future reports or updatesthat may be requested._______________________________________________________________ ___________Applicant’s Signature Date5