Application for Substitute Nurse



Dear Substitute Applicant:

Thank you for your interest in substituting in Spartanburg School District Two. Please note that at a substitute nurse must have an RN license for the State of South Carolina. In order to be considered as a potential substitute, please submit the following items:

  1. A completed substitute application form.
  2. Two letters of reference. Please send these to the individuals of your choice and ask them to send the completed form directly to the District Office.
  3. A completed W-4 Form for payroll purposes.
  4. S.C. Department of Health Form 1420, Certificate of Evaluation for Tuberculosis. Tests are available through the local health department. State law requires us to have a TB test on file for all employees. THE FEE FOR THIS TEST IS THE RESPONSIBILITY OF THE APPLICANT.
  5. Form I-9, Employment Eligibility Verification Form. This requires two forms of identification and must be signed by the applicant. Acceptable forms of identification include a copy of the applicant's social security card and driver's license.
  6. A completed Criminal Record History from South Carolina Law Enforcement Division. Please complete the attached form. DO NOT SEND THIS REPORT TO SLED. WE WILL PROCESS AND ADD TO YOUR FILE WHEN RETURNED.
  7. Copy of Current CPR Card.

Please complete and return the attached forms as soon as possible. Once we have received all of the requested information, we will notify you as to when you will be added to the substitute list. PLEASE NOTE THAT A SATISFACTORY CRIMINAL RECORD HISTORY REPORT IS REQUIRED.

We appreciate your interest in working with the students in Spartanburg School District Two. If you have any questions, please feel free to contact our office.

Sincerely,

G. Brantley Enloe
Director of Personnel

Spartanburg County School District 2
Administrative Offices
4606 Parris Bridge Rd.
Boiling Springs, SC 29316
Phone: (864) 578-0128
Fax: (864) 578-8924



Last Name: First Name: Middle Name:
Address:
Primary Telephone:
Social Security Number:
Email address:
If you only want to sub at a particular school or school level, please indicate: Choice:


EDUCATIONAL AND PROFESSIONAL TRAINING
High School Date
From		High School Date
To		Name & Location of High SchoolDiploma
Received
Yes No
College Date
From		College Date
To		Name & Location of CollegeDegree
Received		Major


EMPLOYMENT RECORD
NURSING EXPERIENCE
Date
From		Date
To		PositionName and Location
of Employer		Reason for
Leaving


PROFESSIONAL INFORMATION
1. Do you presently hold a RN license?
If certified in another state, please specify: License Number: Expiration Date:
2. Do you have an Application on file in District Two?
3. Are you eligible to live and work in the U.S.?
4. Have you ever been dismissed or had your contract not renewed by a school district?
If yes, explain:
5. Have you ever been convicted of a crime?
If yes, explain:
6. Do you hold a Current CPR Card?


REFERENCES
Please list the names, titles, addresses and numbers of at least two (2) people who can give you a valid professional and/or character reference. Two reference forms must be returned to the District Office for your file to be complete.
Name and PositionStreet AddressCity, State, ZipTelephone



By filing this application for employment, I authorize a full investigation with regard to all answers given in this application. I also understand that misrepresentation or omission of any requested information shall be a reason for non-employment or immediate dismissal, if employed. Employment is also conditional upon receipt of a satisfactory criminal record report, TB test, the return of two completed personal reference forms, and the I-9 Verification of Employment Eligibility Form.

I agree to these terms:


Substitute nursing applications are kept in the active file for one year only. Written or telephone requests to update your file will be accepted to maintain the file on active status.

Spartanburg County School District Two does not discriminate on the basis of race, color, religion, natural origin, age, handicap, or veteran status in the provision of educational opportunities and benefits in compliance with Title VI and VII of the Civil Rights Act of 1964, Tile IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the employment provisions (Tile I) of the Americans With Disabilities Act of 1990, and all other applicable civil rights laws.