Bath Public Schools
39 Andrews Road
Bath, ME 04530
(207) 443-6601
APPLICATION FOR SUBSTITUTE TEACHING POSITION
THE BATH PUBLIC SCHOOLS DOES NOT DISCRIMINATE IN THE OPERATION OF ITS EDUCATION AND EMPLOYMENT POLICIES AND WILL HONOR ALL APPROPRIATE LAWS RELATIVE TO DISCRIMINATION.
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Date: ____________________________________
Name: ___________________________________ Social Security No.: ________ - ________ - ______
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.
No. of Yrs.
College/University Attended Degree Awarded (if any) Attended Grade Point Average
__________________________ _________________________ ________ ____________________
__________________________ _________________________ ________ ____________________
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CERTIFICATION: List certification(s) you hold and provide copies of certification.
Type State Date Issued Date of Expiration
__________________________ _______________________ ____________ _________________
__________________________ _______________________ ____________ _________________
__________________________ _______________________ ____________ _________________
State of Maine law requires that all public school employees be fingerprinted and a background check complete prior to being issued any type of Maine certification and beginning employment. You must have your fingerprints taken through a process approved by the Maine Department of Education. Information regarding fingerprinting sites in Maine is available at: http://www.informe.org/cgi-bin/doe/fingerprint.pl.
FINGERPRINTING/BACKGROUND CHECK: Complete: ______ Expiration Date: ________
Not Complete: ______ Date of Fingerprinting Registration: ____________________
EXPERIENCE: Please list previous teaching/substituting experience. Please attach a copy of your resume.
Grade/Subject Position Employer Date (from/to)
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________________ ___________________ _______________________________ _____________
________________ ___________________ _______________________________ _____________
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AREAS OF INTEREST:
1. Please indicate grade level(s) at which you are interested in substituting:
K - 2 _____ 3 - 5 _____ 6 - 8 _____ 9 - 12 _____ Special Education _____
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 junior high or high school level, please indicate the specific subject areas:
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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, the 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.
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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 Bath Public Schools contacts in connection with my employment application to fully provide the Bath 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 Bath Public Schools, its agents and officials or against any provider of such information.
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.
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Signature/Date
APPLICATION FOR SUBSTITUTE TEACHING POSITION CHECKLIST: 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)
_____ Fingerprinting/Background check complete
_____ 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 BATH 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.