Substitute Staff Interest

You are invited to complete this survey to be included in a list of potential substitute teachers for child care programs in the Pittsburgh area. Any information you share here will be made available to directors. All contacts and employment arrangements are between you and the child care program exclusively and directly. Child Care Lounge makes no guarantees and will not be held liable for any results of such arrangements.

* 1. Name

* 2. Are you at least 18 years old?

* 3. Highest level of education?

* 4. Please specify all college degrees by type and major.

* 5. How much experience have you had caring for children in any settings?

* 6. How much experience have you had in an early childhood classroom?

* 7. Do you have two letters of reference available?

* 8. Are you currently employed at child care facility?

* 9. How far are you willing to travel for an assignment?

* 10. What is the least amount of notice you need before an assignment?

* 11. What length of assignments will you consider? Mark all that apply.

* 12. What is the earliest that you are available?

* 13. What is the latest that you are available?

* 14. Mark all days that you are available.

* 15. Do you have a current health assessment and TB test?

* 16. Do you have a copy of requests for the criminal history record and child abuse
registry clearance information, a copy of the disclosure statement and a copy of
the completed clearance information required under the CPSL?
(• Pennsylvania Child Abuse History Clearances (CY113)
• Pennsylvania Criminal Record Checks (SP4-164)
• Federal Bureau of Investigations (FBI) Criminal Background Checks)

* 17. What age groups are you willing to work with? Mark all that apply.

* 18. Minimum salary requirements?

* 19. What else do you wish for a director to know about your qualifications, availability or restrictions?