SUBSTITUTE TEACHER APPLICATION

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COWAN COMMUNITY SCHOOL CORPORATION
9401 S. Nottingham St.,
Muncie, IN 47302
(765) 289-4866 Fax: 284-0315

Digital Signature

****By selecting "I Accept" and typing your name, you are signing this document electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this document. By submitting this document using any device, means or action, you consent to the legally binding terms and conditions of this document. You further agree that your signature on this document (hereafter referred to as your "Digital Signature") is as valid as if you signed the document in writing.**** *

I accept

Name *

Address *

City *

State *

Zip Code *

Phone Number *

Grades/Subjects you are interested in substitute teaching: *

Personal Data

Education: High School Diploma *

Yes

University 1

Enter more than one if it applies

1. Name of college or university

1. Dates Attended

1. Year of Graduation

1. Degree

University 2

2. Name of college or university

2. Dates Attended

2. Year of Graduation

2. Degree

University 3

3. Name of college or university

3. Dates Attended

3. Year of Graduation

3. Degree

WORK EXPERIENCE *

Please list a minimum of the last 2 years of work experience

May we contact the employers listed above? *

Yes

INDIANA CERTIFICATION /SUBSTITUTE PERMIT

Please send/attach a copy in an email of your license(s)/substitute permit. If you do not have a license/permit, indicate when you made application.

RETIREMENT

Are you (or have you been) a member of the Indiana State Teacher’s Retirement Fund *

Yes

If you circled YES, please indicate your membership number:

REFERENCES

(List at least two individuals) List: Name, Position, Address and Telephone.

1. *

2. *

Signature of Applicant: *

Date: *

YYYY

(To the best of our knowledge, this application complies with current law. The information requested is used only for school corporation administrative/statistical purposes.)

It is the policy of this Corporation that no candidate for a position in this Corporation shall be discriminated against on the basis of race, color, religion, national origin or citizenship status, creed or ancestry, age, gender, marital status, non-disqualifying disability, height, or other protected categories.

In accordance with Federal law, any person employed by this Corporation must provide evidence that s/he is eligible to work in the United States.

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