Town of Lincoln Public Schools

TOWN OF LINCOLN PUBLIC SCHOOLS

1624 Lonsdale Avenue Lincoln, Rhode Island 02865 Telephone: (401) 721-3300 www.lincolnps.org Fax: (401) 721-3342

Substitute Teacher Application

Date: ______Name: ______Address: ______City/Town: ______State: ______Zip: ______Telephone: ______Cell Phone: ______Certification Number:______Expiration Date: ______Area(s) of Certification: ______

1. Are you a retired teacher? ___Yes ___No If yes, what state did you retire from? ______

2. Which days are you available to substitute? Mon. Tues. Wed. Thurs. Fri.

3. Please indicate the school(s) that you are interested in substituting in:

 Central Elementary  Saylesville Elementary  Middle School  Lonsdale Elementary  Senior High School  Northern Elementary

Please submit the following items along with this application: 1. Copy of RI Teacher Certification 5. W-4 Form (available on our website) 2. Proof of MMR immunity (if born 1957 or later) 6. I-9 Form (available on our website) 3. TB test results (within past 6 months) 7. Proof of authorization to work in the 4. Nationwide BCI check results United States (see list of acceptable documents on pg. 2 of I-9 form)

Your application will be considered complete when all of the items listed above have been provided. This is not a guarantee of employment. Those individuals who best suit the needs of our school system will be added to our substitute list. The Superintendent, School Principals, or Assistant Principals may remove the name of an individual from the list of acceptable substitute teachers at his/her discretion.

______FOR PERSONNEL USE ONLY:

 Certification  W-4  TB test results within the past 6 months  BCI check results  I-9 with documentation  MMR Immunity (if born 1957 or later)

The Lincoln School Department does not discriminate on the basis of age, sex, sexual orientation, race, religion, national origin, or disability in accordance with applicable laws and regulations. PERSONAL DATA (Please type or print.) Have you ever been employed by the Town of Lincoln? Yes No If yes, dates?

Are you prevented from becoming lawfully employed in the United States because of Visa or Immigration Status? Yes No NOTE: Proof of citizenship or Immigration Status will be required upon employment.

On what date will you be available to work? Are you a Veteran of the U. S. Military Service? Yes No If yes, branch:

List professional, trade, business or civic activities and offices held:

NOTE: You may exclude memberships which would reveal gender, race, religion, national origin, age, ancestry, handicap or other protected status.

REFERENCES - These should be persons other than relatives qualified to answer concerning your fitness for the position you seek. Include superintendents, principals, or other supervisors under whom you have taught or worked for. Name, Title Address Telephone

EDUCATION Name & Address of School Course of Years Diploma Study Completed Degree High School

Undergraduate College

Graduate Professional

The Lincoln School Department does not discriminate on the basis of age, sex, sexual orientation, race, religion, national origin, or disability in accordance with applicable laws and regulations. Other (specify) TEACHING EXPERIENCE - Start with most current experience. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. Include any job- related military service assignments and volunteer activities. Name & Address of School Dates Subject or Last Salary Reason for Grade Leaving

OTHER EMPLOYMENT - Start with most current experience. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. Include any job- related military service assignments and volunteer activities. Name & Address of Employer Dates Position Last Salary Reason for Leaving

SPECIAL SKILLS, QUALIFICATIONS, and CERTIFICATIONS - Please summarize special skills, qualifications, and certifications acquired from your previous employment, education and/or life experiences.

The Lincoln School Department does not discriminate on the basis of age, sex, sexual orientation, race, religion, national origin, or disability in accordance with applicable laws and regulations. APPLICANT STATEMENT I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for six months. A Letter of Intent should be submitted for each position I wish to be considered for, and at that time my application on file will be updated. At the conclusion of the six months, if I still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant ______

Date ____/_____/_____

The Lincoln School Department does not discriminate on the basis of age, sex, sexual orientation, race, religion, national origin, or disability in accordance with applicable laws and regulations. The Lincoln School Department does not discriminate on the basis of age, sex, sexual orientation, race, religion, national origin, or disability in accordance with applicable laws and regulations.