MILAN SPECIAL SCHOOL DISTRICT
PHONE NUMBER ___________________ SOCIAL SECURITY NUMBER ______________________
SCHOOL OR SCHOOLS WHERE YOU WOULD LIKE TO SUBSTITUTE _______________________
Circle Days Preferred: Monday Tuesday Wednesday Thursday Friday ALL
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
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
DATE ______________________________ SIGNED _________________________________________
(Type of print name here)