Substitute Teacher Application
Name: / Date:
Address: / Home Phone:
City, ST ZIP / Cell Phone:
E-Mail / Work/Other:
Have you ever been convicted of a felony or misdemeanor? / Do you hold a Utah Teaching Certificate? Yes No
Yes No
Educational Background
High School / School / Location / Year or Graduation
College/
Undergraduate / School / Dates Attended / Major/Minor / Degree / Year of Degree
College/
Graduate / School / Dates Attended / Major/Minor / Degree / Year of Degree
Teaching Experience: Years experience as a teacher under a regular contract in a public school, most recent first.
School / District / State / Years Taught / Grade / Subject
If retired as a teacher, when did you retire? / From what school district:
Did you hold a Utah certificate when you retired? / Yes
No / What days are you available for substitute work?
Grades or subjects that you would like to substitute
Additional Comments:
In accordance with Utah State Law, Murray City School District may conduct a criminal background check. I understand that the school district will receive information as the result of the background check. I also certify that the information listed is true and correct and any misrepresentation of facts may be grounds for dismissal. I also give the above information for Murray City School District use only and all information will be kept confidential. Employment will be subject to passing of the background check.
Signed Date
It is the policy of the Murray City School District to provide and promote equal opportunity employment, compensation and other terms and conditions of employment without discrimination because of race, color, sex, religion, national origin, age or disability. The district provides reasonable accommodations to the known disabilities of applicants in compliance with the Americans with Disabilities Act. Murray School District is committed to its policy of keeping its work force free from sexual harassment.
147 East 5065 South / n / Murray, UT 84107(801) 264-7400 / n / (801) 264-7456 (fax)