ITEMS NEEDED WHEN MAKING A RESERVATION. $50.00 non-refundable fee in the form of cash (please have exact change).

To:

Substitute Teacher Applicants

From:

Lynne Dawson, Workshop Coordinator

The Union School District requires that all prospective substitute teachers attend a workshop for our district.

At this workshop, you learn district substituting procedures, review employment paperwork, and review

substitute responsibilities. Please read the following information carefully.

 ATTEND

A

DISTRICT

WORKSHOP

Workshops last approximately three hours, and are held at the Education Service Center

at 8506 E. 61

_{St., Tulsa, OK 74133. Reservations are required and must be made in}

person with the Human Resources receptionist. Seating is limited to only those

persons who have made a reservation and paid the $50.00 non-refundable fee in

advance. Human Resources will take your reservation and fee payment starting two

weeks prior to the next scheduled workshop. Once your reservation fee has been paid,

you may request the substitute packet from the receptionist or print a copy from your

computer. The packet is located on the Union website under Employment, Substitute

Personnel. Please check our website at

www.unionps.org

or call 918-357-4321 for any

changes to the workshop schedule. Please bring your completed substitute packet

with you to the workshop.

 COMPLETE

AN

ONLINE

APPLICATION

HTTPS

://

.

.

12.

/

/I

.

 ITEMS NEEDED WHEN MAKING A RESERVATION

$50.00 non-refundable fee in the form of cash (please have exact change).

Oklahoma school districts are required by law to send a fingerprint card for each new employee to

the Oklahoma State Department of Education as part of the required background check process.

You will be given an instruction letter to take to the Tulsa County Sheriff’s Office at the substitute

workshop. As a requirement of employment with Union Public Schools, you must take the letter to

the Sheriff’s office and complete the fingerprinting process prior to turning in your completed

application packet. If we do not receive your fingerprint card, we cannot legally employ you.

Thank you for your interest in Union Public Schools and we look forward to seeing you at a Substitute

Workshop in the near future.

SUBSTITUTE TEACHER WORKSHOP SCHEDULE 2015-2016

Thursday, September 3

9:00a.m. - noon

Thursday,

September

17

9:00a.m.

-

noon

Tuesday,

October

13

9:00a.m.

-

noon

Wednesday,

October

28

9:00a.m.

-

noon

Wednesday,

November

18

9:00a.m.

-

noon

Wednesday,

December

9

9:00a.m.

-

noon

Tuesday,

January

5

9:00a.m.

-

noon

Tuesday,

January

26

9:00a.m.

-

noon

Wednesday,

February

10

9:00a.m.

-

noon

Thursday,

March

3

9:00a.m.

-

noon

Tuesday, April 12 (Student Interns)

9:00a.m. - noon

The times listed above are the start times of the workshops. Late arrivals

will be required to make up the portion of the workshop missed before

being considered for addition to the substitute list.

Please check our website for any changes to the above schedule at

www.unionps.org

HR-110 Revised 2/08

Revised 8/10

UNION PUBLIC SCHOOLS

BASIC EMPLOYEE INFORMATION FORM

This form must be completed for all new employees. Please PRINT legibly.

A. BIOGRAPHICAL INFORMATION

1. S.S. # _________-______-____________

2. NAME ______________________________________________________________________________________________ First Middle Last

3. BIRTH DATE __________/__________/__________ (mm/dd/yyyy)

4. PRIMARY PHONE (____) _____________ Home/Cell/Other SECONDARY PHONE (____) _____________ Home/Cell/Other 5. GENDER (M/F) _______________________________ PRIMARY LANGUAGE SPOKEN

6. ARE YOU HISPANIC OR LATINO? YES NO

6a. ETHNICITY & RACE CATEGORY (Check as many as apply):

AMERICAN INDIAN OR ALASKA NATIVE (I) ASIAN(A) BLACK OR AFRICAN AMERICAN(B) NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER(P) HISPANIC/LATINO(H) WHITE (W) 7. HOME ADDRESS ____________________________________________________________________________________ Street

____________________________________________________________________________________ City State Zip

IF ADDRESS IS A PO BOX PLEASE LIST PHYSICAL ADDRESS _______________________________________________ Street

_______________________________________________ City State Zip

IS ADDRESS TO BE UNLISTED? __ Yes __ No

FOR H.R. USE ONLY

8. LOCATION ________________________________ SCHOOL _______________________________

PAY LOCATION ____________________________ DEPT. __________________________________

ASSIGNMENT ______________________________

9. SPOUSE’S NAME ____________________________________________________________________________________ First Middle Last

SPOUSE’S WORK PHONE ( _____ ) ______________________ CELL PHONE ( _____ ) ______________________

10. HIRE DATE _________________________________ (First day worked in position)

11. EMERGENCY CONTACT (Name) __________________________________________RELATION ______________________ CONTACT’S PHONE Primary ( ___ ) _____________ Home/Cell/Other Secondary (___ ) _____________ Home/Cell/Other CONTACT’S ADDRESS _______________________________________________________________

Street

_______________________________________________________________ City State Zip

12. HAVE YOU BEEN EMPLOYED BY UNION SCHOOLS BEFORE? ______ Yes ______ No IF YES, WHEN WERE YOU EMPLOYED? _______________________________________________

13. ARE YOU A RETIREE UNDER OKLAHOMA STATE TEACHERS’ RETIREMENT SYSTEM? ______ Yes ______ No 14. CERTIFIED: YES NO

_{COMPLETE BOTH SIDES}

HR-110 Revised 2/08

Revised 8/10

B. EDUCATION INFORMATION (Post-Secondary)

14. SCHOOLS ATTENDED:

* SCHOOL _______________________ DEGREE ________________________ YEAR _________

ADD’L HOURS _____________ MAJOR ____________________ MINOR __________________

* SCHOOL _______________________ DEGREE ________________________ YEAR _________

ADD’L HOURS _____________ MAJOR ____________________ MINOR __________________

* SCHOOL _______________________ DEGREE ________________________ YEAR _________

ADD’L HOURS _____________ MAJOR ____________________ MINOR __________________

* SCHOOL _______________________ DEGREE ________________________ YEAR _________

ADD’L HOURS _____________ MAJOR ____________________ MINOR __________________

15. AREAS OF SPECIAL TRAINING OR EXPERIENCE _________________________________________________________

__________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________

As a condition of employment, all employees are required to enroll in direct deposit and remain enrolled in direct deposit for the tenure of employment.

All new hires will be required to enroll in direct deposit at the time of hire.

Once enrolled in direct deposit, an employee’s first paycheck will require a “pre-note” with their bank. Therefore, direct deposit will not be effective until the second paycheck after signing up for direct deposit. Employees with a district e-mail address will receive their direct deposit advice via e-mail. All others will be delivered to their site or mailed to their home address.

For those employees unable to obtain a bank account, employees shall contact the Payroll department for assistance. Adopted 12/12/11

Union Public Schools

Direct Deposit Authorization/Change Form

Name__________________________________________________SS#_______________________________

Last First MI

#1 PRIMARY DIRECT DEPOSIT 100% OF Net Balance-

Bank Name _________________________________________________________________________________ Transit/ABA # _________________________________Account # ______________________________________ _____Checking Account ______Savings Account

_____Add ______Change _______Cancel

Are these funds forwarded to a bank in another country? _________ Yes ___________No

#2 SECONDARY DIRECT DEPOSIT (Fixed Amount $______________ Each Payday)

Bank Name__________________________________________________________________________________

Transit/ABA # __ ________________Account # ______________________________________ ____Checking Account _____Savings Account

____Add ______Change _______Cancel

Are these funds forwarded to a bank in another country? __________Yes _____________No

™ DUE TO THE TIME REQUIRED FOR BANK PROCESSING, ALLOW TWO PAY PERIODS FOR PROCESSING. YOU WILL RECEIVE A CHECK DURING THE INTERIM UNTIL THE CHANGE CAN BE PROCESSED.

Please read carefully and sign below:

I hereby authorize Union Public Schools to deposit my pay directly to my account and for the DEPOSITORY FINANCIAL INSTITUTION (bank, savings & loan, credit union) named above to make a credit entry to such account. If monies to which I am not entitled are deposited to my account, I authorize Union Public Schools to direct the financial institution to return said funds. I understand the payroll date and frequency of payment currently being utilized by my employing agency will not be affected by my decision to use Direct Deposit. I have read and understand the information provided on Direct Deposit.

This authority is to remain in full force and effect until I give the payroll office 30 calendar days’ written notice using this form to cancel this Direct Deposit agreement. This information is provided by me to facilitate my personal banking needs and shall be considered personal and held in confidence.

Signature___________________________________________________________________ Date______________________ Please attach a voided check(s) (deposit slips are not accepted) or an official document from your financial institution showing the financial institution’s routing number and your account number in this space. Allow 30 days for Direct Deposit to commence.

X:\Departments\HR\New Employee Paperwork

Revised 4/20/07

To be used in conjunction with Sterling Consent Disclosure Form

Union Public Schools

CRIMINAL BACKGROUND CHECK

In compliance with Oklahoma Statutes (Title 70, Sections 122, 125, 135,

and 140.1) which prohibit public schools from retaining or rehiring an

individual with a felony conviction, Union Public Schools (“Union”)

requires a criminal background check for purposes of making

employment decisions.

I,

, give Union Public Schools permission

to run a background check to obtain criminal information relating to me

(if any) and/or to hire a reporting agency to run a background check to

obtain criminal information relating to me (if any) contained in public

records. Neither Union Public Schools or its agent(s) will be violating

my right to privacy by conducting this background check, and I hereby

release them from all liability whatsoever for actions related to this

investigation. I further acknowledge that, if I am hired by Union, I may

be subject to additional background checks pursuant to an annual

random selection process for criminal history checks of ongoing Union

employees, and I grant permission for these additional background

checks.

________________________________ _____________________________

Signature

Date

Certified _____

Support _____

Substitute _____

UNION PUBLIC SCHOOLS

LOYALTY OATH

I do solemnly swear (or affirm) that I will support the Constitution and the laws of

the United States of America and the Constitution and the laws of the State of

Oklahoma, and that I will faithfully discharge, according to the best of my ability,

the duties of my office or employment during such time as I am an employee of

Independent School District No. 9 of Tulsa County, State of Oklahoma.

________________________________

Affiant

(signature)

________________________________

Print name

Subscribed and sworn to before me this _______ day of _____________, 20___.

________________________________

Notary Public

Created 5/2010 Revised 8/2010

Voluntary Ethnicity and Race Identification

Privacy Act Statement

Ethnicity and race information is requested under the authority of 42 U.S.C. Section 2000e-16 and in compliance with the Office of Management and Budget's 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. Providing this information is voluntary and has no impact on your employment status, but in the instance of missing information, your employing agency will attempt to identify your race and ethnicity by visual observation.

This information is used as necessary to plan for equal employment opportunity throughout the Federal government. It is also used by the U. S. Office of Personnel Management or employing agency maintaining the records to locate individuals for personnel research or survey response and in the production of summary descriptive statistics and analytical studies in support of the function for which the records are collected and maintained, or for related workforce studies.

Social Security Number (SSN) is requested under the authority of Executive Order 9397, which requires SSN be used for the purpose of uniform, orderly administration of personnel records. Providing this information is voluntary and failure to do so will have no effect on your employment status. If SSN is not provided, however, other agency sources may be used to obtain it.

Specific Instructions: The two part questions below are designed to identify your ethnicity and race. Regardless of your answer to Question 1, go to Question 2.

Question #1

Are you Hispanic or Latino?

(A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)

Yes No Question #2

Please select the racial category or categories below with which you most closely identify by placing an “X” in the appropriate box.

(Check as many as apply)

Racial Category

(Check as many as apply)

Definition of Category

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

A person having origins in any of the black racial groups of Africa.

A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

For District purposes of being able to determine staff diversity (by the employee’s self-designated primary ethnicity/ race),if you have indicated more than one race designation above, please indicate (on a voluntary basis/not required) the ethnicity/race you would consider to be your primary ethnicity/race: ______________. Name (Last, First, Middle Initial) Social Security Number Birthdate (Month and Year)

Name: Date:

Specify the grade level you wish to teach:

All Pre-K-5th 9th

6th

7th 10th-12th (HS)

8th Alternative Ed

Specialty classes you are willing to teach:

All P.E. SED

Art Foreign Language

Music Media/Library

Drama Nurse

Subjects you PREFER to teach:

Subjects you PREFER NOT to teach:

Elementary schools preferred:

All Andersen Jarman

Boevers Jefferson

Briarglen McAuliffe

Cedar Ridge Moore

Clark Peters

Darnaby Rosa Parks

Grove

Rosa Parks ECEC

Remarks:

Union Public Schools

CC-Form-1A

_{Oklahoma Workers' Compensation Notice and Instruction to Employers and Employees}

All employees of this employer who are entitled to benefits of the Administrative Workers' Compensation Act are hereby notified that this employer has complied with all rules of the Workers' Compensation Commission and that this employer has secured payment of compensation for all employees and their dependents in accordance with the Act. All employees are further notified this employer will furnish first aid, medical, surgical, hospital, optometric, podiatric, and nursing services, medicine, crutches and other apparatus as may be reasonably necessary in connection with the injury received by the employee, as well as payments of compensation to any injured employee or the employee’s dependents as provided in the Act.

Any employee who has suffered a compensable injury covered by the Administrative Workers' Compensation Act is entitled to vocational rehabilitation services, including retraining and job placement, if, as a result of the injury, the employee is unable to perform work for which the person has previous training or experience.

The Oklahoma Workers' Compensation Commission has a Counselor Division to provide information to injured workers, employers, and other interested persons.

Mediation is available to help resolve certain workers’ compensation disputes. For information, call the Counselor Division at 405-522-8760 or In-State Toll Free 800-522-8210.

Signature of Employer

Insurer Name and Address

Employee's Responsibilities In Case of Work Related Injury

If accidentally injured or affected by cumulative trauma or an occupational disease arising out of and in the course of employment, however slight, the employee should notify the employer immediately. If this employer is a partnership, notice shall be given to any partner. If this employer is a corporation, notice shall be given to any agent or officer of the corporation upon whom legal process may be served. Notice shall also be given to the person in charge of business at the location of operations where the injury occurred. Unless oral or written notice is given to the employer within thirty (30) days, the claim for compensation may be forever barred.

The employee may file a claim for compensation with the WORKERS’ COMPENSATION COMMISSION for an accidental injury, death, cumulative trauma or occupational disease or illness occurring ON OR AFTER February 1, 2014. Forms to file a compensation claim should be furnished by this employer and also are available from the Workers’ Compensation Commission. The forms are posted on the Commission’s website, www.wcc.ok.gov.

A claim for compensation must be filed with the Commission within the time specified by law, or be forever barred. Based on law effective February 1, 2014, a claim for compensation for any accidental injury or death must be filed with the Commission within one (1) year of the date of injury or death; a claim for compensation for occupational disease or illness must be filed within two (2) years of the last injurious exposure; and a claim for compensation for cumulative trauma must be filed within one (1) year of the date of injury. A claim for additional compensation is barred unless filed within one (1) year of the last payment of disability compensation or two (2) years from the date of injury, whichever is longer.

Claims for compensation for accidental injury, death, cumulative trauma or occupational disease or illness occurring BEFORE February 1, 2014 may be filed with the WORKERS’ COMPENSATION COURT OF EXISTING CLAIMS and are subject to different notice of injury requirements and claims filing deadlines than those for accidental injury, death, cumulative trauma or occupational disease or illness occurring on or after February 1, 2014. Failure to comply with applicable notice requirements and deadlines may operate to forever bar the claim. Contact the Commission’s Counselor Division for additional information.

Employer's Responsibilities

The employer must provide employees with immediate first aid, medical, surgical, hospital, optometric, podiatric, and nursing services, medicine, crutches and other apparatus as may be reasonably necessary in connection with the injury received by the employee. This applies to care for all injuries and illnesses arising out of and in the course of employment, regardless of their character. Within ten (10) days after the date of receipt of notice or knowledge of death or injury that results in more than three days’ absence from work for the injured employee, the employer MUST send a report thereof to the Workers’ Compensation Commission on a CC-Form 2, and also send a copy of the CC-Form 2 to the employer’s insurance carrier, if any, within the ten-day period.

No agreement by any employee to pay any portion of the premium paid by the employer to a carrier or a benefit fund or department maintained by the employer for the purpose of providing compensation or medical services and supplies as required by the workers’ compensation laws, shall be valid. Any employer who makes a deduction for such purposes from the pay of any employee entitled to benefits under the workers’ compensation laws shall be guilty of a misdemeanor.

No agreement by any employee to waive workers' compensation rights and benefits shall be valid. Any person who commits workers' compensation fraud, upon conviction, shall be guilty of a felony

punishable by imprisonment, a fine or both.

Workers' Compensation Commission

1915 North Stiles Avenue Oklahoma City, Oklahoma 73105-4918

Tele. 405-522-3222 (OKC) · 918 -581-2714 (TU) · In-State Toll Free 800-522-8210

This notice must be posted and maintained by the employer in one or more conspicuous places on the work premises. Created 2-1-14

Date of Expiration of Insurance Policy (Not applicable to employers authorized to self-insure.)

*

after you notified your supervisor, five days went by without Union Schools offering you medical treatment.

Explanation of Required Provider of Medical Treatment for Work-Related

Injury

As an employee of Union Public Schools, if you experience a work-related injury, you are responsible for immediately reporting that injury to your supervisor. Workers’ Compensation laws in Oklahoma have recently changed regarding medical treatment for work-related injuries. As always, if you are injured at work, you must notify your supervisor immediately (as soon as you know you have an injury). You will be required to go to the medical facility/doctor that has been designated by Union Public Schools as the provider of medical services for work-related injuries (see attachment), and you do not, by law, have the choice of going to your own physician at the time of the injury.*

Union Public Schools has a Certified Workplace Medical Plan through WorkNet of Oklahoma, and you are required to go to the medical facility listed on the

attachment.* (The specific facility utilized will depend on the hour of day you are seeking treatment per the attachment).

If you go to your own doctor for a work-related injury, your medical treatment will likely be disqualified for payment under workers’ compensation.* You (or your own personal health insurance) would be responsible for bill for treatment anywhere other than at the required medical facility (as per the attachment).

• For an emergency work injury, an ambulance would be called, and the

facility to which you were taken for treatment would be paid under workers’ compensation.

By my signature, I acknowledge that I understand if I am injured at work at Union Public Schools, I am required to report this injury immediately to my supervisor, and I am required to go for treatment at the facility/facilities designated in the attachment. I acknowledge that I have noted the exceptions below. I am also signifying by my signature that I did receive a copy of this agreement and also a copy of the attachment designating the required facilities. I understand a copy of this document will be kept in the District’s file of WorkNet acknowledgements.

________________________________ __________________________

Employee Date

________________________________ __________________________

WorkNet of Oklahoma

A Certified Workplace Medical Plan

Tulsa Area – Broken Arrow

Occupational/Medical Clinic

MedNow

Walk-in Urgent Care Center

503 South Aspen

Broken Arrow, OK 74012

Hours:

Monday through Friday– 8 a.m. to 8 p.m.

Saturday & Sunday – 9 a.m. to 4 p.m.

For injuries after hours or on weekends:

Tulsa/Broken Arrow Area Hospitals

Note: For emergency care, after-hour or weekend care

Saint Francis at Broken Arrow

Saint Francis Hospital

St. John Medical Center

Union Public Schools Independent District #9

Human Resources • 8506 E 61st Street • Tulsa, OK 74133-1926 • (918) 357-6190 • Fax (918) 357-6199

  To:  Applicants for Positions* at Union Public Schools  Re:  Notice Regarding Required National Criminal Record Check(s) and Post Offer/Pre‐Employment Drug Testing    Thank you very much for your interest in working for Union Public Schools.  As required by Oklahoma State law for all  school districts, any applicant who is ultimately recommended to be hired for a position with the Union Public School  District (the District), will be required to be fingerprinted for a national criminal record search to be conducted through  the Oklahoma State Bureau of Investigation (OSBI) system.  Additionally, it is a District requirement that any applicant  who receives a contingent offer of employment from the District must take and pass a drug test.    If you are recommended by the hiring administrator for a position at the District, a staff member in the Human Resources  (HR) Department will contact you to give you specifics of the fingerprinting and drug testing process and to set a time for  your HR interview/new hire paperwork session.    The fingerprint process will require you to take a letter from the District to the Sherriff’s office for your electronic  fingerprints.  You will be given specific instructions regarding this process (along with a map and directions to the  Sherriff’s office).  You must bring your driver’s license or state‐issued ID card with you for your fingerprinting session. The  District will forward your fingerprint card to the State Department of Education for an OSBI criminal record search.   Additionally, a criminal record search will be done through a private criminal record search provider.  Information from  either of the criminal record checks run by the District may disqualify you from employment with the District.  You will not  be required to pay any of the cost for the fingerprinting or for the national criminal record searches.*    For the drug testing process, after receiving a contingent offer of employment you will be instructed to take a form  (provided by HR) to the drug testing facility utilized by the District. You will be given a copy of the District’s drug testing  policy at the same time you pick up your drug test form and your fingerprint information.  There will be a time frame  within which you must complete your drug test (within one hour of receiving the drug testing form).  You will be provided  directions to the drug testing facility where your form will be “stamped” by the facility to verify you took your drug test  within the required time frame.  You will not be required to pay any of the cost of the drug test.    You must bring the “stamped” drug test form (verifying you took your drug test) and your completed fingerprint card back  to the HR Department at the time HR will schedule for your new hire paperwork appointment.  You will not be eligible to  be hired by the District until you have provided your fingerprint card for the required OSBI criminal record search, brought  back your stamped drug test form, and met all other requirements communicated to you by the HR Department.    A drug test result that is positive for illegal substances or positive for certain drugs for which the individual has no  prescription, will disqualify the candidate from employment with Union Public Schools.  If you are ultimately hired by the  District, you will be hired for up to 60 days pending the results of your national criminal record checks.  If, during that 60  day period, the District receives any information from the results of the national criminal record searches that disqualifies  you from employment with the District (or if the District receives disqualifying drug test results after you have begun  employment), your employment will be terminated.       We appreciate your understanding and cooperation in meeting requirements that assure appropriate hiring for public  schools.  Thank you again for your interest in working for the Union Public School District.    *If applying for a position as a substitute teacher, a fee applies for participating in the Substitute Workshop.