"Substitute Credential Application" - New Jersey

Substitute Credential Application is a legal document that was released by the New Jersey Department of Education - a government authority operating within New Jersey.

Form Details:

  • Released on October 15, 2014;
  • The latest edition currently provided by the New Jersey Department of Education;
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(REV. 10.15.14)
STATE OF NEW JERSEY – DEPARTMENT OF EDUCATION
DIVISION OF FIELD SERVICES AND OFFICE OF CERTIFICATION AND INDUCTION
SUBSTITUTE CREDENTIAL APPLICATION
COUNTY:
MUST
NOTE: THIS APPLICATION
BE TRANSMITTED TO THE COUNTY OFFICE IN WHICH THE SPONSORING DISTRICT IS LOCATED
This credential will be issued for a five-year period, but the holder may serve for no more than 20 total instructional days in the same position in one school district
during the school year unless approved by the Executive County Superintendent for an additional 20 instructional days pursuant to N.J.A.C. 6A: 9B-6.5(b). Such
credentials, which are issued by the Executive County Superintendent of Schools under the authority of the State Board of Examiners, are designed only for
emergency purposes when the supply of properly certificated substitutes is inadequate to staff a school. They are intended only for persons temporarily
performing the duties of a fully certificated and regularly employed teacher.
TO BE COMPLETED BY APPLICANT -- Please Type or Print Clearly
Name
Social Security #
(First)
(Middle/Maiden)
(Last)
Address
(Street)
(City)
(State)
(Zip)
Date of Birth
E-Mail Address
Telephone
Are you a citizen of the United States? Yes
No
If no, have you filed an Affidavit of Intent to Become a Citizen? Yes
No
If yes, Alien Registration #
NOTE: The Affidavit of Intent to Become a Citizen is not a requirement for the substitute credential.
Have you ever been convicted of a crime in this or any other state? Yes
No
If yes, give the name of the municipality and attach statement giving details.
Have you ever had an educator’s certificate revoked or suspended in this or any other state? Yes
No
If yes, attach statement giving details.
Have you taken the Oath of Allegiance? Yes
No
EDUCATION
Regionally-Accredited College Name
Location
Degree / Degree Date
Major
# Credits
WORK EXPERIENCE (teaching)
I certify that the above statements and data are correct:
(Signature of Applicant)
(Date)
FOR DISTRICT OR DISTRICT DESIGNEE* USE: AFFIRMING TRANSMITTAL OF APPLICATION
_
_
Print Name of District Representative or District Designee Representative
Signature of District Representative or District Designee Representative
_
Name of District for Which Application is Transmitted
Date
*District designee is defined as a vendor / firm that contracts with the district for this purpose.
Name Vendor / Firm if Transmitted by Designee
FOR COUNTY USE:
REGULAR SUBSTITUTE APPLICATION
VOCATIONAL / SCHOOL NURSE APPLICATION
Application
Oath
Transcripts
Fee
For vocational applicants/notarized statement of previous employment or
valid occupational license.
Date of Criminal History Approval if applicable
or
RN License #
Exp.Date
Date of Emergent Hire Approval if applicable
CERTIFICATE #
DATE OF ISSUE
(REV. 10.15.14)
STATE OF NEW JERSEY – DEPARTMENT OF EDUCATION
DIVISION OF FIELD SERVICES AND OFFICE OF CERTIFICATION AND INDUCTION
SUBSTITUTE CREDENTIAL APPLICATION
COUNTY:
MUST
NOTE: THIS APPLICATION
BE TRANSMITTED TO THE COUNTY OFFICE IN WHICH THE SPONSORING DISTRICT IS LOCATED
This credential will be issued for a five-year period, but the holder may serve for no more than 20 total instructional days in the same position in one school district
during the school year unless approved by the Executive County Superintendent for an additional 20 instructional days pursuant to N.J.A.C. 6A: 9B-6.5(b). Such
credentials, which are issued by the Executive County Superintendent of Schools under the authority of the State Board of Examiners, are designed only for
emergency purposes when the supply of properly certificated substitutes is inadequate to staff a school. They are intended only for persons temporarily
performing the duties of a fully certificated and regularly employed teacher.
TO BE COMPLETED BY APPLICANT -- Please Type or Print Clearly
Name
Social Security #
(First)
(Middle/Maiden)
(Last)
Address
(Street)
(City)
(State)
(Zip)
Date of Birth
E-Mail Address
Telephone
Are you a citizen of the United States? Yes
No
If no, have you filed an Affidavit of Intent to Become a Citizen? Yes
No
If yes, Alien Registration #
NOTE: The Affidavit of Intent to Become a Citizen is not a requirement for the substitute credential.
Have you ever been convicted of a crime in this or any other state? Yes
No
If yes, give the name of the municipality and attach statement giving details.
Have you ever had an educator’s certificate revoked or suspended in this or any other state? Yes
No
If yes, attach statement giving details.
Have you taken the Oath of Allegiance? Yes
No
EDUCATION
Regionally-Accredited College Name
Location
Degree / Degree Date
Major
# Credits
WORK EXPERIENCE (teaching)
I certify that the above statements and data are correct:
(Signature of Applicant)
(Date)
FOR DISTRICT OR DISTRICT DESIGNEE* USE: AFFIRMING TRANSMITTAL OF APPLICATION
_
_
Print Name of District Representative or District Designee Representative
Signature of District Representative or District Designee Representative
_
Name of District for Which Application is Transmitted
Date
*District designee is defined as a vendor / firm that contracts with the district for this purpose.
Name Vendor / Firm if Transmitted by Designee
FOR COUNTY USE:
REGULAR SUBSTITUTE APPLICATION
VOCATIONAL / SCHOOL NURSE APPLICATION
Application
Oath
Transcripts
Fee
For vocational applicants/notarized statement of previous employment or
valid occupational license.
Date of Criminal History Approval if applicable
or
RN License #
Exp.Date
Date of Emergent Hire Approval if applicable
CERTIFICATE #
DATE OF ISSUE