Mr. Mrs.
Ms. Dr.
(optional) / Name (last) / (First) / (Middle Initial)
Permanent Address (Street/P.O. Box) / City / State / Zip Code
Telephone No. / Cell Phone No. / Email Address
Please check all positions would be interested in as a substitute and are certified:
Teacher / Instructional Asst. / Secretary/Receptionist / Custodian / Cafeteria
Present Position:
Address
Telephone No.
EDUCATIONAL AND PROFESSIONAL TRAINING
School or Institution and Complete Mailing Address / Major / Diploma or
Degree / Semester Hours Credit
High School:
Address:
Undergraduate School:
Address:
Graduate School:
Address:
Are you current working toward an advanced degree? Yes No
CERTIFICATION (if applicable)
Specific area(s) of certification:
Certification Status: Active Inactive
Please attach a copy of your teaching certification/professional license.
STUDENT TEACHING OR INTERN EXPERIENCE (if applicable):
School or Institution Name and Complete Mailing Address / Name of Supervising Teacher / Grade/Subject / Telephone
Name:
Address:
Name:
Address:
TEACHING/PROFESSIONAL EXPERIENCE (if applicable):
School or Institution Name and Complete Mailing Address / Position and Field and/or Special Program / Dates
From To / No. of Years
Name:
Address:
Name:
Address:
REFERENCES
Name / Title/Business / Mailing Address / Telephone No.
PART-TIME EMPLOYMENT
Are you restricted to working only certain hours of the day?Yes No
If yes, indicate hours available:
Are you restricted to working only certain days of the week?Yes No
If yes, indicate only the days available: M T W TH F
PLEASE READ CAREFULLY
Applicant’s Certification and Agreement
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that this application does not constitute a contract for employment. Election of all substitutes is subject to receipt of confirming credentials for personnel files and approval by the Board of Trustees. I understand that if employed, falsified statement on this application or any supplement thereto shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation and contact any person or companies names in this application. I hereby waive my right to access confidential statement made in recommendations used solely for employment.
Signature of Application: ______Date: ______
Please return completed application and have credentials forwarded to:
York Academy Regional Charter School
Attn: Human Resources
32 W. North Street
York, PA 17401
NOTE: Interviews are optional and may be scheduled after application AND credentials have been received.
Employment cannot be offered until a completed Act 34 Criminal History, Act 151 Child Abuse History, FBI Clearance, and tuberculosis test have been received.
It is the policy of the York Academy Regional Charter School not to discriminate on the basis of race, color, national origin, sex, employment practices, as required by Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and Title VI of the Civil Rights Act of 1964. Inquiries regarding compliance with any of these statues may be directed to the Chief Academic Officer, York Academy Regional Charter School, 32 W. North Street, York, PA 17401, (717) 801-3900.
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