<p> SCHOOL DISTRICT OF BONDUEL P.O. Box 310 400 West Green Bay Street Bonduel, WI 54107 (715) 758-4860</p><p>SUBSTITUTE TEACHER APPLICATION</p><p>Name: ______Date: ______</p><p>Present Address: ______(Street) (City) (State) (Zip) Permanent Address: ______(Street) (City) (State) (Zip) Telephone Numbers: ______(Present) (Permanent) (Work) E-Mail Address: ______Social Security Number: ______</p><p>My signature below authorizes the school district to conduct a background investigation and authorizes release of information in connection with my application for employment. This investigation may include such information as criminal or civil convictions, driving records, previous employers and educational institutions, personal references, professional references, and other appropriate sources. I waive my right of access to any such information, and without limitation hereby release the school district and reference sources from any liability in connection with its release or use. Furthermore, I certify that I have made true, correct and complete answers and statements on this application in the knowledge that they may be relied upon in considering my application, and I understand that any omission or falsely answered statement made by me on this application or any supplement to it will be sufficient grounds for failure to employ or for my discharge should I become employed with the school district.</p><p>Date ______Signature ______</p><p>In addition to a completed application form applicants must submit a resume’, copy of college transcripts and a Wisconsin Teaching License and three letters of recommendation.</p><p>CERTIFICATION</p><p>If you have been issued a Wisconsin certificate, please submit a photocopy. Copy enclosed? No [ ] Yes [ ]</p><p>Type of Wisconsin Certification: Initial [ ] Renewal [ ] 1 Year [ ] Lifetime [ ] Special [ ]</p><p>WI Certification Expiration Date ______Endorsement(s) ______</p><p>______</p><p>Wisconsin Certification Applied for? Yes [ ] No [ ] When? ______</p><p>The School District of Bonduel does not discriminate on the basis of age, race, color, national origin, creed, sex sexual orientation, physical or developmental handicap, marital status, arrest record or conviction record in its programs, activities, or employment. EDUCATIONAL AND PROFESSIONAL TRAINING (List Chronologically)</p><p>Name and Location Field of Type of Year of of College or University Study Degree Graduation</p><p>______</p><p>______</p><p>______</p><p>STUDENT TEACHING OR INTERNSHIP EXPERIENCE</p><p>Name and Location Grade Level and/or Dates of of School District Subjects Taught (from...to)</p><p>______</p><p>______</p><p>TEACHING EXPERIENCE (List Chronologically. Do not list substitute experience)</p><p>Name and Location Grade Level and/or Dates of of School District Subjects Taught (from...to)</p><p>______</p><p>______</p><p>______</p><p>______</p><p>GENERAL INFORMATION</p><p>Substitute teaching assignment preference: High School Yes [ ] No [ ]</p><p>Middle School Yes [ ] No [ ] </p><p>Special Education Yes [ ] No [ ]</p><p>Elementary School Yes [ ] No [ ] </p><p>Elementary Grade Level Preference ______</p><p>______GENERAL INFORMATION (continued)</p><p>Have you ever been discharged or requested to resign from a position? Yes [ ] No [ ] (if yes please explain) ______</p><p>Have you ever been convicted of a crime other than a minor traffic violation? Yes [ ] No [ ] (if yes please explain. Note: a criminal record does not constitute an automatic disqualification from employment, but will be considered only as it relates to the job) ______</p><p>Have you ever had a teaching certificate suspended or revoked? (if yes please explain) Yes [ ] No [ ] ______</p><p>Are any criminal charges or proceedings pending against you? (if yes please explain) Yes [ ] No [ ] ______</p><p>Have you ever been convicted of any offense involving the sexual molestation, physical or sexual abuse, or rape of a child? (if yes please explain) Yes [ ] No [ ] ______</p><p>WORK EXPERIENCES (other than teaching in the past five years)</p><p>Place of Employment Type of Work (from...to)</p><p>______</p><p>______</p><p>______</p><p>______</p><p>REFERENCES</p><p>It is the applicants responsibility to provide the names of three reference sources including current employer if employed, or last employer if not currently employed. Applicants who are beginning teachers must include references from their student teaching supervisor and cooperating teacher.</p><p>Name of Reference Position/Relationship Mailing Address Phone Number</p><p>______</p><p>______</p><p>______</p>