PINEYWOODS COMMUNITY ACADEMY

Employment Application for
SUBSTITUTE TEACHER


We consider applicants for all positions without regard to race, color, national origin, age, religion, sex, marital status, veteran or military status, disability or any other legally protected status. - AN EQUAL OPPORTUNITY EMPLOYER



Date: Tuesday, May 23, 2017















Resume 
All teaching and professional certificates or licenses 
Copies of all transcripts showing degrees (an official transcript will be required upon hiring) 

Yes  No 



High School Graduate
GED
Less than two years of college
Two or more years of college
Bachelors Degree
Masters Degree
Other Training or Education



Name of School Location Course of Study and major/minor Diploma, degree, certificate, or license held

Please provide a complete list of all positions you have held in the past 10 years. List the most recent first. Attach additional sheets, if necessary. Attach resume, if available.
Name of School District Location Type of Assignment/Title Dates Employed Reason for Leaving


None 
Valid Texas 
Valid Other State  
Texas Emergency 
Texas One-Year: Expires  
Texas Temporary Administrative: Expires  



Please provide a list of all other jobs or administrative positions you have held in the past 10 years. Attach additional sheets, if necessary. Attach resume, if available.
Employer Address Position/Title Dates Employed Reason for Leaving

Please list the days you are available to substitute and your assignment preferences.

Monday 
Tuesday 
Wednesday 
Thursday 
Friday 

Elementary 
Middle School 
High School 
Special Education 

Yes  No 
(The amount of time that an individual receiving TRS benefits may be employed without affecting benefits is governed by TRS rules and laws.)


Yes  No 


Yes  No 

(A felony conviction is not an automatic bar to employment. The district will consider the nature, date and relationship between the offense and the position for which you are applying.)


Please list references the district can contact regarding your work history. Include all managers and supervisors who evaluated or supervised your performance at your last two employers.
Name of Reference School District/Firm Name Mailing Address Position/Title Phone Number (with area code)

I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge and understand that any deliberate falsifications, misrepresentations or omissions of fact may be grounds for rejection of my application or dismissal from subsequent employment.

I authorize the above-listed references to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all such parties from liability for any damage that may result from furnishing the same to you.

(A)I understand that the agency to which I am applying may use my Social Security Number (SSN) for tracking purposes and for identification. This is in accordance with Federal Law U.S.C. 552a Section 7 (b)

Signature:
Date: Tuesday, May 23, 2017

This application becomes the property of the district. The district reserves the right to accept or reject it. This application shall be considered active for 18 months. If you have not received a response during this time period, you may reapply or reactivate your application.


The Pineywoods Academy is authorized by state law to obtain criminal history record information and fingerprints on applicants the district intends to employ. (Texas Education code §22.083 and Senate Bill 9) The information requested below is necessary to obtain criminal history record information.













Male  Female