Section I: Personal Information

First Name

Middle Name

Last Name

Address

City

State

Zip

Phone

Date Available (mm/dd/yyyy)

Do you have a student attending Frederica Academy?

Yes No

If yes, please list name or names.

Do you have a valid Teaching Certificate?

Yes No

If yes, please provide a copy.

Max file size: 10 MB

Section II: Work History

Begin with your most recent job or current work status. Please also submit a resume.

Submit Resumerequired

Max file size: 10 MB

Current/Last Employer

Address

Telephone

From MM/YY - MM/YY

Job Title

Supervisor's Name

Reason for Leaving

Employer

Address

Telephone

From MM/YY - MM/YY

Job Title

Supervisor's Name

Reason for Leaving

Section III: Substitute Preferences

Section IV: References

List below four individuals to be contacted as personal/employment references. Your current or most recent supervisor must be listed as a reference. Please do not use family members as references.

Name

Telephone

Name

Telephone

Name

Telephone

Name

Telephone

Section V: Personal Affirmation

I verify that all information that I have provided on this application is complete and true to the best of my knowledge. If approved, I agree to abide by the policies, rules and regulations of Frederica Academy. Any violation of these rules and regulations may result in my name being removed from the list of approved substitute teachers. Furthermore, I understand that nothing in the substitute application is intended to create an employment contract with Frederica Academy. I am aware that substitute teachers are utilized on an "as needed" basis. No promises of employment have been made to me and I understand that substituting at Frederica Academy is not guarantee of employment now, or in the future.

I also give Frederica Academy permission to contact my current employer or past employers as shown on my substitute application and the additional references provided. I further release and hold harmless both Frederica Academy and my prior employer(s) from any and all liability that may potentially result from the release and/or use of such information. I understand that any information released by my prior employer will be held in the strictest confidence by Frederica Academy, that it will be viewed only by those involved in the hiring decision, and that neither I nor anyone else not so involved will have the right to see the information.

I acknowledge that I have carefully read and fully understand the provisions of this release. This release sets forth the entire agreement between Frederica Academy and me, and I acknowledge that I have not relied upon any representation or statement, written or oral, not set forth in this document.

Name

Date (mm/dd/yyyy)

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