Substitute Application

USD 112 Central Plains SUBSTITUTE APPLICATION

Unified School District 112 600 S. Main Street, Box 168, Holyrood, Kansas 67450 785-252-3695
Date (MM/DD/YYYY)
Full Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Email Address
Social Security #
Level(s) Preferred

K-3 K-6 4-6 7-8 7-12 9-12
Teaching areas preferred:
Teaching experience:
Date and place of last teaching position:
Additional teaching levels and areas you will substitute, if needed:
Education
Other colleges or universities attended:
Certification
Upload a copy of your current teaching certificate or mail a copy of your certificate to 600 S. Main, PO Box 168, Holyrood, KS 67450
Three References: (Former employers or supervisors)
Electronic Signature: Type full name
Birth Date

Month Day Year
Should be Empty:

USD 112 Central Plains SUBSTITUTE APPLICATION