Baxter Academy for Technology & Science Substitute Application Packet
TO: FROM: RE:
Substitute Teachers Tia Wilson, Operations & Admissions Manager Process for Applying for Substitute Teaching
PLEASE NOTE: A minimum of 2 years of college is required in order to be able to substitute with Baxter Academy The following is a brief description of the process which is used in order to become a substitute teacher at Baxter Academy. An application must be completed prior to being called for substituting in our system. 1. Completed application packet is required, which includes the following: a. Application b. 2 written letters of reference c. Resume d. 1-9 (must bring forms of identification to office to be approved) e. W-4 f. W-4ME g. Copy of current fingerprint authorization h. Employee Emergency Contact Form i. Direct deposit j. Bangor Payroll Form 2. Completed application must be returned in person to Baxter Academy. The I-9 form will be completed by a staff member – please remember to bring required documentation on the back of the I-9 form 3. Once the application process is completed, your resume will be reviewed by our Head of School and if it is approved, you will be added to our substitute list. 4. On each day you work, please check in with the Front Office to let them know. You will then be recorded on a timecard. Payroll is on the 1st and 15th of every month. Check stubs are mailed to your home. It is important to notify us of any address changes. Substitute pay is $75 per day, for the 1st three times you work, on the 4th scheduled day, you will be paid $90 per day you work, until the end of the school year. If you continue to substitute for us, the $75 rate of pay will start over at the start of each school year. Benefits are not offered to substitute teachers. 5. If you need to terminate your position as a substitute teacher, please do so but notifying us in writing.
We hope you have a great time subbing for us at Baxter Academy for Technology & Science!
Substitute Employee Check List
I-9 Form Completed
W-4 State & Federal Completed
Identification (2 forms)
Copy of Fingerprint Authorization Card
Application
Resume
2 Letters of Written Reference
Employee Emergency Contact Form
Bangor Payroll Form
Direct Deposit Form
(Passport, Driver’s License, Social Security Card, Birth Certificate)
Baxter Academy for Technology & Science Substitute Teacher Application **Baxter Academy does not discriminate in the operation of its education and employment policies, and will honor all appropriate laws related to discrimination** Date: Name: Address:
Phone:
Email:
EDUCATION: College/University Attended
Degree Awarded (if any)
No. of Yrs Attended
CERTIFICATION: List certification(s) you hold and provide copies of these certifications. Date Type State Issued
G.P.A
Date of Expiration
EXPERIENCE: Please list previous teaching/substituting experiences. Please attach a copy of your resume. Grade/Subject Position Employer Dates (from/to)
REFERENCES: Please provide three references who are not related to you but who are familiar with your work as a teacher, substitute or who know of your experience working with youth. Name Relation Phone
Please indicate the day(s) you are available to substitute: Monday
Tuesday
Wednesday
Thursday
Friday
BACKGROUND: Have you ever been disciplined, discharged, or asked to resign from a prior position?
Yes
No
Have you ever resigned from a prior position after a complaint had been received against you, or your conduct was under investigation or review?
Yes
No
Has your contract in prior position ever been non-renewed?
Yes
No
Have you ever been charged with or investigated for sexual abuse or harassment of another person?
Yes
No
Have you ever been convicted of a crime (other than a minor traffic offense)?
Yes
No
Have you ever entered a please of guilty or “no contest” to any crime (other than a minor traffic offense)?
Yes
No
Have you ever had a professional license or certificate suspended or revoked in any state or have you ever voluntarily surrendered, temporarily or permanently, a professional license or certificate in any state?
Yes
No
Has any court ever deferred, filed or dismissed proceedings without a finding of guilty and required that you pay a fine, penalty or court costs and/or imposed a requirement as to your behavior or conduct for a period of time in connection with any crime (other than a minor traffic offense)?
Yes
No
If you have answered YES to any of the previous questions, provide full details below including, with respect to court actions, the date, offense in question, and the address of the court involved. Attach additional sheets if necessary. Conviction or other disposition of a crime is not necessarily an automatic bar to employment.
SIGNATURE: My signature below constitutes authorization to check my employment history, including without limitation, criminal arrest and conviction record checks and reference checks. I understand that information submitted in and with this application may be disclosed to a screening and/or interview committee, which may include board members, administrators, other staff, and members of the community. I give my consent to this disclosure.
Signature
Date
MAINE DEPARTMENT OF EDUCATION APPLICATION FOR INITIAL EDUCATIONAL APPROVAL W Z
1. NAME (First, MI, Last, and optional suffix such as Jr., III)
2. Social Security Number -
4. Mailing Address
9. Home Phone
11. Date of Birth / / mo. day yr.
DATE
-
5. EMAIL Address
10. Sex ____ Male ____ Female
3. Other name(s) under which Your records are filed
6. City or Town
7. State
8. Zip Code
RETURN TO: DEPARTMENT OF EDUCATION CERTIFICATION OFFICE 23 STATE HOUSE STATION, AUGUSTA, ME O4333-0023
THE FOLLOWING QUESTIONS MUST BE ANSWERED: 1. 2. 3.
Have you ever been convicted of ANY crime? ____ YES ____ NO Have you ever had any occupational or professional license or credential suspended or revoked in any state, or voluntarily surrendered an occupational or professional license or credential? ____ YES ____ NO Have you ever resigned following allegations of physical or sexual abuse? ____ YES ____ NO
If the answer is yes to any of the above, please attach a detailed explanation with required court documents. (See enclosed instructions.) Have you had your fingerprints taken as required by the Criminal History Record Check? (See enclosed instructions.) _____ YES
_____ NO
If yes, where ________________________________________________
Date: ________________________
I authorize the Dept. of Education to charge the applicable fees for this application:
M/C ___ VISA ___ EXPIRATION DATE _____ CREDIT CARD NUMBER _______________________________ I hereby declare or affirm under penalty in the law for unsworn falsification that this application, and any supporting documentation provided in support of this application, contains no willful misrepresentations or falsifications and that the information given by me is true, accurate, and complete to the best of my knowledge and belief, and so far as based on information and belief, I believe the information to be true. I understand that my answers may be verified and that I may be declared ineligible for certification and subject to civil or criminal penalties if there are any misrepresentations.
SIGNATURE OF APPLICANT ____________________________________________ DATE ______________________
DEPT. USE ONLY
C
Unless you receive an exception, you will be approved to be employed in the schools of Maine in a position for which you are otherwise qualified. The local school unit is responsible for determining whether you are otherwise qualified for a job category. EFC-300-C REV 12/12
Operations & Admissions Manager Wilson, Tia M. 54 York Street
Baxter Academy for Technology & Science Portland
ME
04222
