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GALAX CITY PUBLIC SCHOOLS

223 LONG STREET

GALAX, VA 24333

(276) 236-2911

(276) 236-2911 Fax

GUIDELINES FOR SUBSTITUTE TEACHER APPLICANTS

1. Applicant must be 21 years of age.

2. Applicant must have high school diploma or equivalent.

Prior to employment the following requirements must be met:

g Applicant must sign forms before a notary which will allow Galax City Public Schools to perform a background

check. The applicant will need driver’s license. The check includes the following:

1. Sex offender registry

2. Criminal background by the local police department

3. Criminal background by the Virginia State Police

4. Child abuse registry as maintained by the Department of Social Services

5. Fingerprint submission

g Application must be returned to School Board Office.

g The applicant mails the attached reference forms to the persons listed as references and requests that the forms be mailed back to Galax City Schools. The application is considered complete upon receipt of the three completed reference forms.

g The application and reference forms must be approved by the Galax School Board.

(Meetings are held on the 2nd

Tuesday of each month)

g Applicant must attend a substitute training session.

g Applicant must complete federal/state tax forms.

g Applicant must obtain a certificate from a physician stating he/she has been screened for TB risk factors. (TB screenings are given at the Galax Health Department on Mondays)

After all requirements have been met, the applicant’s name will be added to our current listing of substitute teachers. Individual schools will call when a substitute teacher is needed.

Current pay for substitute teachers is $70.00 a day for persons with a four year degree and $53.00 a day for non-degreed persons.

If you have any questions, please call 236-2911.

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GALAX CITY PUBLIC SCHOOLS

223 Long Street

Galax, VA 24333-4298

(276) 236-2911 Fax (276) 236-5776

EMPLOYMENT APPLICATION - SUBSTITUTE TEACHER

All questions must be answered for the application to be complete. Applications will remain active for one calendar year. Please type or print in ink.

NAME

LAST FIRST MIDDLE

MAILING ADDRESS PHONE

HAVE YOU EVER BEEN CONVICTED OF ANY OFFENSE INVOLVING THE ABUSE, MOLESTATION OR RAPE OF A CHILD?

EDUCATIONAL BACKGROUND

HIGH SCHOOL DATES ADDRESS COLLEGE/UNIVERSITY DATES ADDRESS

AREA OF STUDY DEGREE

OTHER

VIRGINIA TEACHING CERTIFICATION YES NO

EMPLOYMENT

1.

COMPANY NAME TELEPHONE

ADDRESS DATES OF EMPLOYMENT

JOB TITLE/DESCRIPTION OF WORK SUPERVISOR

2.

COMPANY NAME TELEPHONE

ADDRESS DATES OF EMPLOYMENT

JOB TITLE/DESCRIPTION OF WORK SUPERVISOR

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3.

COMPANY NAME TELEPHONE

ADDRESS DATES OF EMPLOYMENT

JOB TITLE/DESCRIPTION OF WORK SUPERVISOR

REFERENCE INFORMATION

THE REFERENCE FORMS PROVIDED MUST BE RETURNED BEFORE APPLICATION IS COMPLETE. PLEASE LIST THE NAMES OF PERSONS TO WHOM YOU HAVE MAILED THE REFERENCE FORMS TO BELOW.

1. NAME ADDRESS POSITION PHONE 2. NAME ADDRESS POSITION PHONE 3. NAME ADDRESS POSITION PHONE

MY SIGNATURE CERTIFIES THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

I HEREBY AUTHORIZE THE OFFICE OF PERSONNEL TO CONDUCT WORK HISTORY, PERSONAL REFERENCE OR POLICE RECORD INQUIRES, AND WAIVE THE RIGHT TO HOLD LIABLE THOSE PERSONS FOR PROVIDING ANY REQUESTED INFORMATION. IT IS UNDERSTOOD THAT SUCH INFORMATION IS TO BE ABSOLUTELY PRIVILEGED, CONFIDENTIAL, AND USED ONLY IN DETERMINING MY QUALIFICATIONS FOR EMPLOYMENT AND ASSIGNMENT.

DATE SIGNATURE SOCIAL SECURITY NUMBER

THE GALAX CITY SCHOOL BOARD DOES NOT DISCRIMINATE ON THE BASIS OF DISABILITY OR SEX IN ADMISSION OR ACCESS TO, OR TREATMENT OR EMPLOYMENT IN ITS PROGRAMS AND ACTIVITIES. DOUGLAS E. ARNOLD IS DESIGNATED AS THE RESPONSIBLE PERSON REGARDING ASSURANCES OF NON-DISCRIMINATION. HE MAY BE REACHED AT THE ADDRESS AND PHONE NUMBER ON THE FRONT OF THIS APPLICATION.

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9/2002

GALAX CITY PUBLIC SCHOOLS

223 Long Street

Galax, VA 24333-4298

(276) 236-2911 Fax (276) 236-5776

EMPLOYMENT APPLICATION - ADDENDUM

Applicant Name Date

I Hereby Certify That I Have Not:

Been convicted of a felony: a misdemeanor involving (i) sexual assault, (ii) obscenity and related

offenses, (iii) drugs, (iv) moral turpitude, or (v) the physical or sexual abuse or neglect of a child,

or an equivalent offense in another state.

Applicant Signature Date

I understand that the Galax City School Board shall require, as a condition of employment, that

any applicant who is offered or accepts employment requiring direct contact with students,

whether full-time, permanent or temporary, provide written consent and the necessary personal

information for the school Board to obtain a search of the registry of founded complaints of child

abuse and neglect. Permission is also granted for a criminal history check.

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9/2002

GALAX CITY PUBLIC SCHOOLS

223 Long Street

Galax, VA 24333-4298

(276) 236-2911 Fax (276) 236-5776

REFERENCE FORM - SUBSTITUTE TEACHER

APPLICANT INFORMATION

NAME

LAST FIRST MIDDLE

I DO I DO NOT WAIVE MY RIGHT TO REVIEW THE INFORMATION PROVIDED BY THIS REFERENCE. DATE SIGNATURE REFERENCE INFORMATION NAME POSITION ADDRESS PHONE

Based on your knowledge of the preparation, experience, and personal qualities of the applicant, please check the level which the applicant consistently performs.

Superior Well Above At Below Satisfactory Not Comments Expectations Expectations Expectations Applicable

1.

Appearance and manner

2. Use of language

3. Attitude

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5. Commitment 6. Ethics

CONTINUED ON NEXT PAGE OTHER

1. Please feel free to make any comments you feel are pertinent to this applicant.

2. How long have you known the applicant? In what relation?

3. Would you hire this person for the position?

4. If the applicant has been employed by you and has been denied employment or encouraged to vacate a position, please explain the circumstances.

5. Is there any information about the applicant that you feel we should know before employment is offered, If so, please explain.

Date Signature

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Please Return to:

Galax City Public Schools Attn: Reference Form 223 Long Street Galax, VA 24333

References

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