Substitute Teacher Application

Substitute Teacher Application




















  • Drop files here or

    Please upload Resume and Cover Letter here or mail to:
    Administrator
    452 Ebenezer Road
    Lebanon, PA 17046
  • Church Information





  • Previous Teaching /Substitute Experience:
  • Educational and Employment Background

  • High School


  • College/University





  • Employment Experience

    List in chronological order. Additional information: please include in resume.
  • MM/YY to MM/YY
  • MM/YY to MM/YY
  • MM/YY to MM/YY
  • References

    List the names of two persons who know directly of your work professionally or of your qualifications for substitute teaching.





    Select all that apply.








    Check all that apply.







    Check all that Apply
  • Certification

    I give the school and its designated representatives permission to contact:






  • ACT 151 (PA Child Abuse History Clearance) Each candidate must submit a copy of an official clearance statement obtained from the Pennsylvania Department of Public Welfare or a statement from the Department of Public Welfare that no record exists. This clearance must be current within one year. The applicant MUST submit the ORIGINAL report prior to employment.

    ACT 34 – PA State Police Criminal Record Check *
    This report must be current within one year. PDE-6004

    ACT 114 of 2006, Section III of the Public School Code * – Federal Fingerprinting
    This clearance must be current within one year.

    ACT 168 – Commonwealth of PA Sexual Misconduct/Abuse Disclosure Release *
    Employment history review submitted by hiring school.

    ACT 24 – Arrest/Conviction Report and Certification Form *
    Required for employment decisions in a school entity.

    * These forms are available on the PA Department of Education website.

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