Boerne Independent School District 123 W. Johns Rd. Boerne, Texas 78006 Phone: 830-357-2000 Fax: 830-357-2089

APPLICATION FOR SUBSTITUTE TEACHER

By completing and submitting this application you are agreeing to complete required fingerprinting at your expense of $50.20. Instructions will be mailed to you regarding this. STATE LAW MAKES THIS A PRE-REQUISITE OF EMPLOYMENT Date of application: __________________ School year applying for: _______________ Are you a certified teacher__________ If yes, grade/subject___________________________ l. Personal Data Name: _________________________________________________________________ Last First Middle Address: _______________________________________________________________ Street or P.O. Box _______________________________________________________________ City State Zip Telephone: (_____) _____________________

Cell phone: (_____) __________________

Driver’s license number: __________________________

State ______________________

Please list the states (other than Texas) and the counties that you have lived in for the last seven years: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ II. Educational Background School(s)

Location

Dates

Major

Minor

Degree(s)

Year Earned

III. Certifications Type of Certifications

Year Earned

State

Level

Teaching Fields/Endorsements

Are you a retired teacher? Circle one: YES NO If yes, date of retirement: ___________________________ *Effective September 1, 2005, Boerne ISD is required to contribute to the Teacher Retirement System (TRS) pension fund a percentage of compensation and pay a health care surcharge for certain TRS retirees employed by the District. Due to these mandatory contributions, the District will consider hiring TRS retirees on a case-by-case basis.

Has your educator certificate ever been sanctioned, suspended or revoked? Circle one: YES NO If yes, please explain: ________________________________________________________________________ ________________________________________________________________________ IV. Experience/Work History Names of Schools/Employers

Location

Dates

Last Position

Reason for Leaving

V. References Name

Address

Phone

Position

VI. General Information 1. List any college honors or activities: ________________________________________________________________________ ________________________________________________________________________ 2. List any community involvement, hobbies and/or interests: ________________________________________________________________________ ________________________________________________________________________

3. List any additional information you would like us to consider: ________________________________________________________________________ ________________________________________________________________________ 4. Have you ever been convicted of or pleaded guilty or no contest (no lo contendere) to, or received probation, suspension, or defer adjudication for a felony or offense involving moral turpitude (including, but nor limited to, theft, rape, murder, swindling, and indecency with a minor)? Circle one: YES NO If yes, please state where, when, and the nature of the offense: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 5. For the period of ten years prior to the date of this application, have you been terminated or non-renewed by any employer (including school districts)? Circle one: YES NO If you have answered yes, please explain: ________________________________________________________________________ ________________________________________________________________________ 6. Please tell us what interests you in substitute teaching and why you are applying: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 7. If you have a degree, please attach a copy of your college transcripts or diploma. Non-degreed please attach a copy of verification of high school graduation. Certified teachers please attach a copy of your teaching certificate(s). Equal access to employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department at 830-357-2078. YOUR APPLICATION MUST BE SUBMITTED WITH A COPY OF YOUR SOCIAL SECURITY CARD AND CURRENT DRIVER’S LICENSE.

____________________________________ Signature

_____________________ Date

NOTICE The Boerne ISD complies with all federal and state equal employment opportunity laws and does not discriminate on the basis of race, color, national origin, sex, disability, age, limited English proficiency or any other basis prohibited by law. While convictions will not necessarily disqualify an applicant from the job for which he or she has applied, such information may be taken into account in determining whether the conduct related to the conviction or investigation is reasonably related to the job for which the applicant has applied. Responses to these questions will be kept confidential and will be used solely for the purposes of initiating further inquiry into an applicant’s criminal history. Rev. 8.1.10

BOERNE INDEPENDENT SCHOOL DISTRICT 123 W. Johns Rd. Boerne, Texas 78006 830-357-2000

CRIMINAL HISTORY CONSENT FORM AND WAIVER FOR EMPLOYMENT WITH THE BOERNE ISD FOR CERTIFIED & NON-CERTIFIED ADMINISTRATIVE, TEACHING, AND SUBSTITUTE TEACHING POSITIONS Texas laws require the Boerne ISD as a school district to conduct criminal history checks on its certified and non-certified administrative, teaching, and substitute teaching employees and job applicants. Section 22.083 of the Texas Education Code provides that school districts shall obtain criminal histories on school district employees generally. Sections 22.0831 and 22.0836 of the Texas Education Code require persons who seek certified or substitute teaching positions to submit to a national criminal history check. Such persons do so by being fingerprinted. Fingerprinting is mandatory for both employees and applicants who are offered positions or who are engaged as probationary employees pending the results of the criminal history process. The offer of employment to a certified administrative, teaching, or substitute teaching (certified or non-certified substitutes) applicant or the continued employment of the person as a probationary employee will be contingent upon the occurrence of two events: 1) fingerprinting compliance in accordance with a schedule directed by the Boerne ISD; and 2) a criminal history report that does not violate the requirements of Texas law or otherwise preclude employment or continued employment under discretion allowed to school districts under state and federal law. The offer of employment to other non-certified teaching or administrative applicants will be contingent upon a criminal history report that does not violate the requirements of Texas law or otherwise preclude employment or continued employment under discretion allowed to school districts under state and federal law. With the exception of certain criminal offenses that absolutely prohibit employment of any certified or non-certified person with a school district, other convictions will not necessarily disqualify an applicant from the job for which he or she has applied. However, such information may be taken into account in determining whether the conduct related to the conviction is reasonably related to the job for which the applicant has applied. All information provided by the employee or applicant shall be treated as confidential information. By the signing of this form you are agreeing to release, discharge and hold harmless the BISD and its employees and representatives as well as all organizations, agencies, corporations, partnerships, governmental entities, law enforcement agencies, individuals, employees and any other person or persons associated with the BISD from all actions, causes of action, claims, demands, liabilities for or by reason of the procuring or use of information provided to the BISD pursuant to the document.

Please provide the following information and responses: _______________________________________ Name (Printed) _______________________________________ Signature _______________________________________ Street Address _______________________________________ City, State and Zip Code _______________________________________ Driver’s license number including state _______________________________________ Social Security Number _______________________________________ Date of birth _______________________________________ Telephone contact number Sex (circle one):

Male

Female

Ethnicity (circle one):

Anglo

African-American

Asian

Hispanic

Other: ____________________

Ver. 8.1.10