Winthrop Public Schools 17A Highland Avenue

(207) 377-2296 Winthrop, ME 04364

APPLICATION FOR SUBSTITUTE TEACHING POSITION

WINTHROP PUBLIC SCHOOLS DOES NOT DISCRIMINATE IN THE OPERATION OF ITS EDUCATIONAL AND EMPLOYMENT POLICIES, AND WILL HONOR ALL APPROPRIATE LAWS RELATIVE TO DISCRIMINATION.

Name __________________________________

Address _____________________________________________

_____________________________________________ Phone ___________________

EDUCATION: Transcripts, including grades, from all college(s)/university(s) attended must be provided. It is essential that this section be completed accurately. Please be advised that you must have a minimum of 60 college credit hours to be eligible for a substitute teaching position.

No. of Yrs.

College/University Attended Degree Awarded (if any) Attended Grade Point Average

_________________________________ ___________________ ___________ ________________

CERTIFICATION: List certification(s) you hold and provide copies of certification. State law requires that all staff, including substitutes, be fingerprinted and obtain a Criminal History Record Check (CHRC) from the DOE based upon the results of the fingerprints. You must provide our office with a copy of your CHRC certificate or proof of registration for fingerprinting before you will be allowed to sub. You may call the Department of Education (DOE) to register – (207) 624-6603 or for more information.

Type State Date Issued Date of Expiration

_________________________________ _________________ ______________ _______________

EXPERIENCE: Please list previous teaching/substituting experience. Please attach a copy of your resume.

Grade/Subject Position Employer Dates (from/to)

_______________ _________________ ____________________________________ __________________

AREAS OF INTEREST:

1. Please indicate grade levels(s) or area in which you are interested in substituting:

K-2 _____ 3-5 _____ 6-8 _____ 9-12 _____ Special Education _____ Nurse _____ Secretarial _____

2. If you are interested in substituting at the elementary level and have a specialty area, please circle the area(s)

Art Music Physical Education Other_______________

3. If you are interested in substituting at the middle school or high school level, please indicate the specific subject areas:

__________________________________________________________________________________________________

________________________________________________________________________________________________

REFERENCES: Please provide three references who are not related to you who are familiar with your work as a teacher, substitute or who know of your experience working with youth.

Name Address Telephone

__________________________________ ____________________________________ __________________

BACKGROUND:

Have you ever been disciplined, discharged, or asked to resign from a prior position? Yes____No____

Have you ever resigned from a prior position after a complaint had been received against you

or your conduct was under investigation or review? Yes____No____

Has your contract in a prior position ever been non-renewed? Yes____No____

Have you ever not been nominated for re-employment in a prior position or ever had your

nomination for re-employment not be approved? Yes____No____

Have you ever been charged with or investigated for sexual abuse or harassment of another person? Yes____No____

Have you ever been convicted of a crime (other than a minor traffic offense)? Yes____No____

Have you ever entered a plea of guilty or “no contest” (nolo contendere) to any crime

(other than a minor traffic offense)? Yes____No____

Have you ever had a professional license or certificate suspended or revoked in any state, or

have you ever voluntarily surrendered, temporarily or permanently, a professional license or

certificate in any state? Yes____No____

Has any court ever deferred, filed or dismissed proceedings without a finding of guilty and required

that you pay a fine, penalty or court costs and/or imposed a requirement as to your behavior or

conduct for a period of time in connection with any crime (other than a minor traffic offense)? Yes____No____

If you have answered YES to any of the previous questions, provide full details below including, with respect to court actions, the date, offense in question, and the address of the court involved. Attach additional sheets if necessary. Conviction or other disposition of a crime is not necessarily an automatic bar to employment.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SIGNATURE:

My signature below constitutes authorization to check my employment history, including without limitation, criminal arrest and conviction record checks, reference checks, and release of investigatory information possessed by any state, local or federal agency. I further authorize those persons, agencies or entities that the Winthrop Public Schools contacts in connection with my employment application to fully provide the Winthrop Public Schools any information on the matters set forth above. I expressly waive in connection with any request for or provision of such information, any claims, including without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I might otherwise have against the Winthrop Public Schools its agents and officials or against any provider of such information. I understand that in accordance with MRSA Title 16 §620 I have the right to access and review any criminal history obtained by the Winthrop Public Schools.

I understand that information submitted in and with this application may be disclosed to a screening and/or interviewing committee, which may include board members, administrators, other staff, and members of the community. I give my consent to this disclosure.

___________________________/____________

Signature / Date

APPLICATION FOR SUBSTITUTE TEACHING POSITION CHECK LIST: The completed employment application cannot be evaluated unless all of the following materials have been provided:

_____ Application form fully completed

_____ Copies of Transcript(s)

_____ Copy of Maine Certification(s)

_____ Copy of resume

_____ YES to any of the questions in the Background section explained

_____ Application signed

NOTE: ALL APPLICATION MATERIALS BECOME THE PROPERTY OF THE WINTHROP PUBLIC SCHOOLS. NONE WILL BE RETURNED. PROVIDING ANY FALSE OR MISLEADING INFORMATION ON THIS APPLICATION OR IN THE APPLICATION OR EMPLOYMENT SCREENING PROCESS SHALL BE FULLY SUFFICIENT GROUNDS TO REFUSE TO EMPLOY THE APPLICANT OR, IF THE APPLICANT HAS BEEN EMPLOYED, TO IMMEDIATELY DISMISS THE APPLICANT/EMPLOYEE.

NOTE: EMPLOYMENT CANNOT BE FINALIZED UNTIL THE APPLICANT HAS COMPLETED REQUIREMENTS FOR BACKGROUND CHECKS AND FINGERPRINTING AS REQUIRED BY MAINE STATE STATUTE.

Winthrop Public Schools 17A Highland Avenue

REVISED: 09/06