Long-term Substitute Screening Form

Long-term Substitute Screening Form
Please complete this form to apply for a long-term substitute teaching position. Your information will help us evaluate your qualifications and fit for our schools.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Highest Level of Education Completed
Do you currently hold a valid teaching certification?
Please list your teaching certifications (if any):
Please indicate your availability for long-term assignments:
Relevant Teaching Experience (last 5 years)
Rows School/Organization Position/Grade Level Start Date End Date
Experience 1
Experience 2
Experience 3
Please rate your proficiency in the following skills:
Rows No Experience Basic Proficient Expert
Classroom Management
Lesson Planning
Differentiated Instruction
Technology Integration
Special Education
Select the grade levels you are willing to teach:
Other
Please provide two professional references (name, relationship, contact information):
Situational Judgment: How would you handle a classroom disruption?
Signature
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Select theme:

Rows	No Experience	Basic	Proficient	Expert
Classroom Management
Lesson Planning
Differentiated Instruction
Technology Integration
Special Education