GALAX CITY PUBLIC SCHOOLS 223 LONG STREET GALAX, VA (276) (276) Fax

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1 1. Applicant must be 21 years of ae. GALAX CITY PUBLIC SCHOOLS 223 LONG STREET GALAX, VA (276) (276) Fax GUIDELINES FOR SUBSTITUTE TEACHER APPLICANTS 2. Applicant must have hih school diploma or equivalent. Prior to employment the followin requirements must be met: Applicant must sin forms before a notary which will allow Galax City Public Schools to perform a backround check. The applicant will need driver s license. The check includes the followin: 1. Sex offender reistry 2. Criminal backround by the local police department 3. Criminal backround by the Virinia State Police 4. Child abuse reistry as maintained by the Department of Social Services 5. Finerprint submission Application must be returned to School Board Office. The applicant mails the attached reference forms to the persons listed as references and requests that the forms be mailed back to Galax City Schools. The application is considered complete upon receipt of the three completed reference forms. The application and reference forms must be approved by the Galax School Board. (Meetins are held on the 2 nd Tuesday of each month) Applicant must attend a substitute trainin session. Applicant must complete federal/state tax forms. Applicant must obtain a certificate from a physician statin he/she has been screened for TB risk factors. (TB screenins are iven at the Galax Health Department on Mondays) After all requirements have been met, the applicant s name will be added to our current listin of substitute teachers. Individual schools will call when a substitute teacher is needed. Current pay for substitute teachers is $70.00 a day for persons with a four year deree and $53.00 a day for non-dereed persons. If you have any questions, please call /2002

2 GALAX CITY PUBLIC SCHOOLS 223 Lon Street Galax, VA (276) Fax (276) EMPLOYMENT APPLICATION - SUBSTITUTE TEACHER All questions must be answered for the application to be complete. Applications will remain active for one calendar year. Please type or print in ink. MAILING LAST FIRST MIDDLE HAVE YOU EVER BEEN CONVICTED OF ANY OFFENSE INVOLVING THE ABUSE, MOLESTATION OR RAPE OF A CHILD? EDUCATIONAL BACKGROUND HIGH SCHOOL DATES COLLEGE/UNIVERSITY DATES AREA OF STUDY DEGREE OTHER VIRGINIA TEACHING CERTIFICATION YES NO EMPLOYMENT 1. COMPANY TELE DATES OF EMPLOYMENT JOB TITLE/DESCRIPTION OF WORK SUPERVISOR 2. COMPANY TELE DATES OF EMPLOYMENT JOB TITLE/DESCRIPTION OF WORK SUPERVISOR

3 3. COMPANY TELE DATES OF EMPLOYMENT JOB TITLE/DESCRIPTION OF WORK SUPERVISOR REFERENCE INFORMATION THE REFERENCE FORMS PROVIDED MUST BE RETURNED BEFORE APPLICATION IS COMPLETE. PLEASE LIST THE S OF PERSONS TO WHOM YOU HAVE MAILED THE REFERENCE FORMS TO BELOW MY SIGNATURE CERTIFIES THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I HEREBY AUTHORIZE THE OFFICE OF PERSONNEL TO CONDUCT WORK HISTORY, PERSONAL REFERENCE OR POLICE RECORD INQUIRES, AND WAIVE THE RIGHT TO HOLD LIABLE THOSE PERSONS FOR PROVIDING ANY REQUESTED INFORMATION. IT IS UNDERSTOOD THAT SUCH INFORMATION IS TO BE ABSOLUTELY PRIVILEGED, CONFIDENTIAL, AND USED ONLY IN DETERMINING MY QUALIFICATIONS FOR EMPLOYMENT AND ASSIGNMENT. DATE SIGNATURE SOCIAL SECURITY NUMBER THE GALAX CITY SCHOOL BOARD DOES NOT DISCRIMINATE ON THE BASIS OF DISABILITY OR SEX IN ADMISSION OR ACCESS TO, OR TREATMENT OR EMPLOYMENT IN ITS PROGRAMS AND ACTIVITIES. DOUGLAS E. ARNOLD IS DESIGNATED AS THE RESPONSIBLE PERSON REGARDING ASSURANCES OF NON-DISCRIMINATION. HE MAY BE REACHED AT THE AND NUMBER ON THE FRONT OF THIS APPLICATION.

4 9/2002 GALAX CITY PUBLIC SCHOOLS 223 Lon Street Galax, VA (276) Fax (276) EMPLOYMENT APPLICATION - ADDENDUM Applicant Name I Hereby Certify That I Have Not: Been convicted of a felony: a misdemeanor involvin (i) sexual assault, (ii) obscenity and related offenses, (iii) drus, (iv) moral turpitude, or (v) the physical or sexual abuse or nelect of a child, or an equivalent offense in another state. Applicant Sinature I understand that the Galax City School Board shall require, as a condition of employment, that any applicant who is offered or accepts employment requirin direct contact with students, whether full-time, permanent or temporary, provide written consent and the necessary personal information for the school Board to obtain a search of the reistry of founded complaints of child abuse and nelect. Permission is also ranted for a criminal history check. Applicant Sinature

5 9/2002 GALAX CITY PUBLIC SCHOOLS 223 Lon Street Galax, VA (276) Fax (276) REFERENCE FORM - SUBSTITUTE TEACHER APPLICANT INFORMATION LAST FIRST MIDDLE I DO I DO NOT WAIVE MY RIGHT TO REVIEW THE INFORMATION PROVIDED BY THIS REFERENCE. DATE SIGNATURE REFERENCE INFORMATION Based on your knowlede of the preparation, experience, and personal qualities of the applicant, please check the level which the applicant consistently performs. Appearance and manner Superior Well Above At Below Satisfactory Not Comments Expectations Expectations Expectations Applicable Use of lanuae 3. Attitude

6 4. Judment 5. Commitment 6. Ethics CONTINUED ON NEXT PAGE OTHER 1. Please feel free to make any comments you feel are pertinent to this applicant. 2. How lon have you known the applicant? In what relation? 3. Would you hire this person for the position? 4. If the applicant has been employed by you and has been denied employment or encouraed to vacate a position, please explain the circumstances. 5. Is there any information about the applicant that you feel we should know before employment is offered, If so, please explain. Sinature

7 Please Return to: Galax City Public Schools Attn: Reference Form 223 Lon Street Galax, VA 24333