Substitute Teacher - Application - Mathis Independent School District

MATHIS INDEPENDENT SCHOOL DISTRICT
602 E. San Patricio Avenue
Mathis, TX 78368
(361) 547-3378
SUBSTITUTE APPLICATION
PLEASE PRINT OR TYPE
Social Security #:____________________________
Date of Application: ______________________________
Full Name: ______________________________________
Other name that may appear on your records:________________
Last
First
Middle Initial
(Used for certification, reference, and criminal history checks)
Mailing Address: ___________________________________________________________________________________
Street/Box
City
State
ZIP Code
Primary Cell Phone (Aesop): _____________________________ Secondary Phone: _____________________________
Email Address: _______________________________________
Please list the days you are available to substitute and your assignment preferences:
Day(s) of week:  Every Day OR Check specific days:  Monday  Tuesday  Wednesday  Thursday  Friday
Assignment:
 Professional
Grade Level(s):  PK-2
 Paraprofessional
 Grades 3-5
 Grades 6-8
 Grades 9-12
 Special Education
Have you ever been fingerprinted through SBEC?  Yes  No
Are you receiving Texas Teacher Retirement (TRS) Benefits?  Yes  No
If yes, date of TRS Retirement: _____________________
Have you been employed by MISD in the past?  Yes  No If yes, list dates of service: _____________________
How many years of experience do you have as a: Full-Time Teacher ___________ Substitute Teacher _____________
Are you related to anyone employed by MISD or to a current school board member? If yes, list name: _______________
Do you substitute in any other school district that utilizes Aesop?  Yes  No
Education: List highest level of education:  High School  Bachelor’s  Master’s College Hrs Earned: _______
Name & Location of Schools Attended
Certificates or Licenses Currently Held:
Course of Study and
Major/Minor
Diploma, Degree, Certificate,
Year
or License Granted
Graduated
 None
 Valid Texas Teacher’s Certificate
 Valid Other State Teaching Certificate ________________
Expiration date: ____________
State
 Other: __________________
List substitute/teacher teaching experience beginning with most recent years.
Principal’s Name
Name and
Location of School Type of Assignment
Dates Taught
& Phone
Reason for Leaving
Please provide a list of all other jobs or administrative positions you have held in the past 10 years. May we contact
your present employer?  Yes  No
Attach additional sheets if necessary. Attach resume if available.
Employer Name
and Location
Position/Title
Dates Employed
Supervisor’s Name
& Phone
Reason for Leaving
Please list references the district can contact regarding your work history.
Full Name of
Reference
School District/
Firm Name
Mailing Address
Position/Title
Area Code/
Phone Number
Have you ever been convicted of, pled guilty or no contest (nolo contendre) to, or received probation, suspension, or
deferred adjudication for a felony or any offense involving moral turpitude (including, but not limited to, theft, rape,
murder, swindling, and indecency with a minor)?  Yes  No
If yes, please state where, when, and the nature of the offense________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
(A felony conviction is not an automatic bar to employment. The district will consider the nature, date, and relationship between the offense and the position for
which you are applying.)
REASONABLE ASSURANCE: By virtue of this notice, please understand that you may not be eligible for employment compensation benefits
drawn on school district wages during any scheduled school breaks including, but not limited to, the summer, Christmas, and spring breaks. This
assurance is contingent on continued school operations and will not apply in the event of any disruption that is beyond the control of the district (i.e.,
lack of school funding, natural disasters, court orders, public insurrections, war, etc.)
REFERENCE AUTHORIZATION: I authorize MISD to contact the references listed above for information concerning my
previous employment and any pertinent information they may have, personal or otherwise, and release all such parties from liability
for any damage that may result from furnishing the same to you.
VERIFICATION: I hereby affirm that all the information provided in this application is true and accurate to the best of my
knowledge, and I understand that any deliberate falsifications, misrepresentations, or omissions of my fact may be grounds for
rejection of my application or dismissal from subsequent employment. I understand that the district is required by Texas Education
Code to review criminal history of all applicants.
_______________________________________
Signature
_______________________
Date
It is the policy of Mathis ISD not to discriminate on the basis of race, color, national origin, sex, handicap or age in its employment practices as required by Title VI of the Civil Rights Act of 1964, as amended;
Title IX of the Education Amendments of 1972; the Age Discrimination Act of 1975, as amended; and Section 504 of the Rehabilitation Act of 1973, as amended. Mathis ISD will take steps to a ssure that
lack of E nglish language skills will not be a barrier to admission and participation in all educational and vocational programs. For information about yo ur rights or grievance procedures contact:
Es norma de distrito escolar de Mathis no discriminar por motivos de raza, color, origen nacional, sexo, impedimento, o edad, en sus procedimientos de empleo, tal como lo requieren el Título VI de la Ley de
Derechos Civiles de 1964, según enmienda; el Título IX de las Enmiendas en la Educación, de 1972, la ley de Discriminación por Edad, de 1975, según enmienda, y la Sección 504 de la Ley de Rehabilitación
de 1973, según enmienda. El distrito escolar de Mathis tomará las medidas necesarias para ase gurar que la falta de habilidad en el uso del inglés no sea un obstáculo para la admisión y participación en
todos los programas educativos y vocacionales. Para información sobre sus derechos o procedimientos para quejas, comuníquese con:
Title IX Coordinator: Director of Human Resources, Dr. Camille McCoy, 602 E. San Patricio Ave, Mathis, TX 78368 (361) 547-3378, Ext: 1040
Section 504 Coordinator: Special Programs Director, Mrs. Christina Alvarado, 602 E. San Patricio Ave, Mathis, TX 78368 (361) 547-3378, Ext: 1200
MISD HR Approved 10/20/15