Lapeer County Intermediate School District

Lapeer County Intermediate School District
1996 West Oregon Street Phone (810) 664-5917 FAX (810) 664-1011
Lapeer, Michigan 48446 Michigan Relay Voice/TTY 800-649-3777
Substitute “District-Specific” Instructions
Dear Applicant,
If you are applying for a substitute position with the Lapeer County Intermediate School District (ISD) or any of
its constituent districts (i.e., Almont Community Schools, Dryden Community Schools, Imlay City Community
Schools, or Lapeer Community Schools), you will need to follow these additional instructions as part of the
enrollment process:
1) If you need to be fingerprinted (i.e., you have not worked in a K-12 school within one year (365
days) of today’s date, in the State of Michigan), you must complete a "LIVESCAN FINGERPRINT
REQUEST" form, which is available (for pick up only) at the following locations:
 THROUGH APRIL 19, 2013 – Lapeer County Intermediate School District (LCISD)
Administration Building, 1996 West Oregon, Lapeer, Michigan 48446.
 AFTER APRIL 19, 2013 – Lapeer County Education and Technology Center, 690 North Lake
Pleasant Road, Attica, Michigan 48412.
2) REPORT IN PERSON and bring with you the following items:
a) an Official Transcript (i.e., with seal) and a Teaching Certificate (if applicable);
b) Driver’s License or State ID;
c) Social Security Card; and
d) The following forms, which can be downloaded, printed and filled out:
(THESE FORMS ARE NOT COMPLETED ELECTRONICALLY.)
 Personal Information;
 Applicant Profile;
 Criminal Records/History Checks Release Authorization; and
 Criminal Records Check – Request Verification.
3) Once your fingerprints have been completed, please return the signed "LIVESCAN FINGERPRINT
REQUEST" form to the LCISD Human Resources Office at 1996 West Oregon in Lapeer. This
form must be returned to our office, prior to employment.
4) Once all of the background checks are completed, you will receive an employment packet from
PCMI via e-mail. Please provide an e-mail address to help facilitate this process more effectively.
Thank you for your interest in working as a substitute in Lapeer County.

Date: _______________________________ E-Mail Address:_____________________________
Last Name: ___________________________ First Name: _______________________ M.I.: _______
Position Applying For: Sub Teacher Sub Paraprofessional Sub Clerical
Gender: Male Female Date of Birth: _____________________________________
Social Security Number: __________________________
Street Address: ______________________________________________________Apt #: ______________
City: _____________________________________________ State: ______ Zip Code: _______________
Primary Phone Number: ______________________ Second Phone Number: _____________________
EDUCATIONAL BACKGROUND (Please complete, if applicable)
High School Diploma GED Associate Degree
Bachelor Degree Major: ___________________________________________________________
Master Degree Major: ___________________________________________________________
Do you have a current valid Michigan Teaching Certificate? Yes No
Certification(s) (Please described in detail):
Have you been fingerprinted for a MI school district under the School Employment Act? Yes No
Have you worked in a MI school (K-12) within one year (365 days) of today’s date? Yes No
Have you completed the G.C.N. Online Training Modules? Yes No

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Race (Please check all that apply):
White / Caucasian Black / African American Hispanic / Latino
American Indian or Alaska Native Asian American
Native Hawaiian or Other Pacific Islander

---------------------------------------------------------------------------------------------------------------------------
Name of EMERGENCY CONTACT:___________________________Relationship____________________
Phone Number______________________ Second Phone Number______________________________

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__________________________________ _____________________________________
Signature Date
CRIMINAL RECORDS/HISTORY CHECKS

RELEASE AUTHORIZATION
Pursuant to the 1993 Public Act 68 and the 1995 Public Act 83, I, the undersigned, understand and
agree that school districts are allowed to share criminal records/history checks required to hire new personnel.
I hereby authorize the Lapeer County Intermediate School District to share my criminal records/history checks
from the Michigan State Police and Federal Bureau of Investigation with other Michigan school districts and
non-public schools, as well as with Professional Contract Management, Inc. (PCMI).
I, the undersigned, do hereby release the Lapeer County Intermediate School District, its individual
board members, employees, and agents, past and present, from any and all claims and/or liability whatsoever
for any damages or consequences which may result from the pre-employment investigation, including the
lawful release of criminal records/history checks, related to my consideration for employment with any
Michigan school district or non-public school, as well as with PCMI.
___________________________________ ___________________________
Signature Date
___________________________________
Print Name
For ISD Use Only:
Date Copy
Sent to PCMI
Initials
Lapeer, Michigan 48446
Michigan Relay Voice/TTY 800-649-3777
CRIMINAL RECORDS CHECK
REQUEST VERIFICATION
Pursuant to the 1993 Public Act 68 and 1995 Public Act 83 requiring a Criminal
Records Check of new education employees, I have completed the Criminal Records
Check procedure for the State of Michigan and the F.B.I. with the
_______________________________________ School District. I hereby authorize
the aforementioned school district to release the results of this Criminal Records Check
(Michigan and F.B.I.) to the Lapeer County Intermediate School District.
I do hereby release the Lapeer County Intermediate School District, its individual board
members, employees, and agents, past and present, from any and all claims and/or
liability whatsoever for any damages or consequences which may result from the pre-
employment investigation, including the criminal records check, related to my
consideration for employment with any Michigan school district or non-public school.
____________________________________ _______________________
Employee Signature Date

Applicant Profile
Name: _____________________________________ Date: ____________________________________
Position(s) you are applying for (check all that apply):

_____ Substitute Teacher _____ Substitute Paraprofessional _____ Substitute Clerical
Please select the school district(s)/building(s) in which you will be willing to substitute:
Substitute Teachers Only
_____ Almont Community Schools (all grades)

_____ Orchard Primary (grades K-4) _____ Almont High School (grades 9-12)
_____ Almont Middle School (grades 5-8)
_____ Dryden Community Schools (all grades)

_____ Dryden Elementary (grades K-6) _____ Dryden Jr/Sr High School (grades 7-12)
_____ Imlay City Community Schools (all grades)

_____ Weston Street Elementary (grades K-2) _____ Borland Elementary School (grades 3-5)
_____ Imlay City Middle School (grades 6-8) _____ Venture High School (alt ed, grades 9-12)
_____ Imlay City High School (grades 9-12)
_____ North Branch Area Schools (all grades)

_____ North Branch Elementary School (grades K-4) _____ Ruth Fox Elementary School (grades 5-6)
_____ North Branch Middle School (grades 7-8) _____ North Branch High School (grades 9-12)
_____ Quest High School (alt ed, grades 9-12)
Substitute Teachers, Paraprofessionals & Clerical
_____ Lapeer County Intermediate School District (Special Education and Career-Technical Ed)
_____ Education and Technology Center (Career & Technical Education)
_____ Education and Technology Center (Special Education)
_____ Lapeer Community Schools (all grades)

_____ Schickler Elementary (grades E5-5) _____ Murphy Elementary (grades K-5)
_____ Lynch Elementary (grades E5-5) _____ Zemmer Middle School (6-8)
_____ Mayfield Elementary (grades E5-5) _____ Rolland Warner Middle School (6-8)
_____ Turrill Elementary (grades E5-5) _____ Lapeer East High (grades 9-12)
_____ Lapeer Community High( alt ed grades 9-12) _____ Lapeer West High (grades 9-12)
(Lapeer Community at Cramton)
Days and Times you are available:

Before Noon: _____ Monday/_____ Tuesday/_____ Wednesday/_____ Thursday/_____ Friday
After Noon: _____ Monday/_____ Tuesday/_____ Wednesday/_____ Thursday/_____ Friday

Lapeer County Intermediate School District

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Substitute “District-Specific” Instructions

2) REPORT IN PERSON and bring with you the following items:

b) Driver’s License or State ID;

c) Social Security Card; and

Thank you for your interest in working as a substitute in Lapeer County.

Date: _______________________________ E-Mail Address:_____________________________

Last Name: ___________________________ First Name: _______________________ M.I.: _______

Position Applying For: Sub Teacher Sub Paraprofessional Sub Clerical

Gender: Male Female Date of Birth: _____________________________________

Social Security Number: __________________________

Street Address: ______________________________________________________Apt #: ______________

City: _____________________________________________ State: ______ Zip Code: _______________

Primary Phone Number: ______________________ Second Phone Number: _____________________

EDUCATIONAL BACKGROUND (Please complete, if applicable)

High School Diploma GED Associate Degree

Bachelor Degree Major: ___________________________________________________________

Master Degree Major: ___________________________________________________________

Do you have a current valid Michigan Teaching Certificate? Yes No

Certification(s) (Please described in detail):

Have you completed the G.C.N. Online Training Modules? Yes No

White / Caucasian Black / African American Hispanic / Latino

American Indian or Alaska Native Asian American

Native Hawaiian or Other Pacific Islander

Phone Number______________________ Second Phone Number______________________________

CRIMINAL RECORDS/HISTORY CHECKS

For ISD Use Only:

CRIMINAL RECORDS CHECK

Employee Signature Date

Name: _____________________________________ Date: ____________________________________

Position(s) you are applying for (check all that apply):

Substitute Teachers Only

_____ Almont Community Schools (all grades)

_____ Dryden Community Schools (all grades)

_____ Imlay City Community Schools (all grades)

_____ North Branch Area Schools (all grades)

Substitute Teachers, Paraprofessionals & Clerical

_____ Lapeer Community Schools (all grades)

Days and Times you are available:

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Date: ___ E-Mail Address:_

Last Name: ___________ First Name: _ M.I.: _

Street Address: ________________________________________Apt #:

City: _____________________________ State: Zip Code: _

Primary Phone Number: __ Second Phone Number: _

Phone Number Second Phone Number________

Name: _ Date: