BELLEVILLE TOWNSHIP HIGH SCHOOL DISTRICT 201 PERSONNEL APPLICATION FORM
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Qualified applicants are considered for all positions without regard
to race, color, religion, gender, national origin, age, marital, or
veteran status, or the presence of a non-job-related medical condition,
or disability.	In compliance with the Immigration Reform and Control
Act of 1986, District 201 intends to hire only individuals authorized
to work in the U.S.	The district does not consider sealed or expunged
records in employment matters.
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Date 	￼

Subject Area/Position:￼__Substitute Teacher

Name￼
Last	First	Middle
Address￼
Street	City	State	Zip Code

Phone Number￼

E-mail Address￼

Citizen of United States? ￼

QUALIFICATIONS AND EDUCATION
Undergrad
Subject Fields	Sem Hours

Major￼	￼

Minor￼	￼

Professional Education	￼
Courses

Graduate

Sem Hours

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List Subjects Qualified
To Teach As They
Appear On Your License
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Universities
Attended

Degrees
Received

Dates
Received

License/Certificate

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High Schools Attended

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Location

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1

Activities and organizations in which you have participated and special honors you have earned
(Exclude groups which indicate race, color, religion, gender, or national origin):

High School￼

College ￼

Community Service ￼

Other Special Honors ￼

Summarize Special Skills or Training ￼
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Membership in Professional or Civic Organizations	(Exclude groups which indicate race,	color,
religion, gender, or national origin):
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Articles Published, Work Exhibited, Etc. ￼
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Have you ever been convicted of felony?

Yes￼.	No￼

If yes, please explain.
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REFERENCES

(List persons not related to you who are most familiar with your professional WORK AND/OR
TRAINING.)

NAME and TITLE

ADDRESS

TELEPHONE NUMBER(S)

1.￼

2. ￼

3.￼

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2

TEACHING EXPERIENCE
Dates
From --	To

Subjects
Taught

School District

Salary

EMPLOYMENT EXPERIENCE
Dates
From -- To

(other than teaching)

Type of Work

Firm or Institution

Salary

CO-CURRICULAR ACTIVITIES - Please list activities in which you have participated.	Indicate
those you have supervised or directed and those you can supervise or direct.

In addition to your academic training, summarize your other qualifications for the position
for which you are applying.

3

Name and address of person to be notified in case of accident or emergency:

Name￼Phone No. ￼

Address ￼

State any additional information, or you may attach any other materials such as a resume, that you
feel may be helpful to us in considering your application.	(You may use the back of this sheet.)

AGREEMENTS

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be
necessary in arriving at an employment decision.	I understand that my employment is subject to the
results of inquiries with references and contacts, and I hereby relieve all references and contacts
from any and all liability concerning the release of any information.

In the event of employment, I understand that incomplete, false, or misleading information given in
my application or interview(s) may result in discharge.	I understand, also, that I am required to
abide by all rules and regulations of District 201.

Further, as a condition of employment, I agree to comply with certain state and federal laws which
require a criminal background investigation, proof of eligibility to work in the United States,
through completion of a federal Form 1-9, and knowledge of and adherence to Illinois statutes
involving child abuse and neglect.

I understand that employment is contingent upon and subject to the results of a post-job-offer
physical and receipt of the criminal background investigation report, as issued by the state of
Illinois.	Further, the board reserves the right to terminate the employment of any employee who has
been convicted of a crime which, in the opinion of the board, makes an employee unsuitable for school
employment.

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Signature of Applicant

Return this application to:	Human Resources
Belleville Township High School District 201
920 North Illinois Street
Belleville, Illinois	62220

10-14-14

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Date