SUBSTITUTE TEACHER

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					                                     SUBSTITUTE TEACHER
                                 MILAN SPECIAL SCHOOL DISTRICT
                                                                                                      SUBFORM



NAME _______________________________________________________________________________


ADDRESS ____________________________________________________________________________


PHONE NUMBER ___________________ SOCIAL SECURITY NUMBER ______________________


SCHOOL OR SCHOOLS WHERE YOU WOULD LIKE TO SUBSTITUTE _______________________

Circle Days Preferred: Monday        Tuesday     Wednesday       Thursday      Friday     ALL

EDUCATION
                  HIGH SCHOOL GRADUATE _____________________________

                  COLLEGE:          1 YEAR ____ 2 YEARS ____ 3 YEARS ____ 4 YEARS ____

                  DEGREE HELD, IT ANY _________________________________

DO YOU HOLD A CURRENT TEACHING CERTIFICATE?                       YES ____ NO ____

IF YES: PROVIDE A COPY

_____________________________________________________________________________________

I hereby certify that I (have) (have not) been convicted of a misdemeanor or a felony in the United States.
If “have” is indicated, explain fully the details of each such conviction on a separate sheet of paper.

I further certify that I (have) (have not) been dismissed from any previous employment for improper or
unprofessional conduct, inefficient service, neglect of duty, incompetence, or insubordination as the same
are defined in Section 49-1401 of the Tennessee Code.
If “have” is indicated, explain fully the details of each such dismissal on a separate sheet of paper. The
employer’s nonrenewal of a yearly contract need not be indicated unless the nonrenewal was for a cause as
listed above.

NOTE: The applicant should exercise extreme care in preparing this application. Information written
herein becomes a legal part of the substitute’s file. False answers may keep the substitute from being
called.



DATE ______________________________ SIGNED _________________________________________


                                                        _________________________________________
                                                                   (Type of print name here)

				
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