substitute teacher registration checklist - roe #3 · substitute teacher registration checklist ....
TRANSCRIPT
Name of Registrant: _____________________________________ Date: _______________
Substitute Teacher Registration Checklist
NOTE: The cost of substitute authorization is $25.00
___________ Check ELIS for existing credentials IEIN:
Make photocopy of State-issued photo I.D. (e.g., valid driver’s license) Evidence of recent medical/physical examination or physician's authorization of good health
(within previous 90 days as per 105 iLCS 5/24-5) (Give applicant a copy of the Physician's Statement of Good Health Form)
[If needed] Download a Physician's Statement of Good Health Form, have it completed by a
physician and submit it with your paperwork.
Fingerprint Criminal Background Check:
Registrant must read and sign Disclosure and Authorization form and submit to ROE.
Registrant must read and sign Substitute Teacher Authorization Form.
Registrant must be given A Summary of Your Rights Under the Fair Credit Reporting Act.
Tell the registrant that this is not a credit history check. It is simply required by the Federal Trade Commission.
appointment scheduling form and gives form to registrant
ROE fills out Bushue Background Screening
ROE logs into Bushue Human Resources web page and creates New Order with registrant information. See Bushue HR Guide for details.
ROE fills out Background Check Request form and FAXes the following two documents to
Bushue HR at (217)342-5653: Background Check Request Form Disclosure and Authorization Form
[OPTIONAL] Substitute fills out Substitute Preference Form and submits to ROE
ROE registrar logs into BushueHR Web Site and Check Reports.
Next page
Print out and save the following:
Statewide Sex Offender Database Check and Statewide Child Murderer and Violent Offender Against Youth Database Check
Illinois State Police will send fingerprint criminal background check results to Regional Superintendent. Regional Superintendent reviews and determines if a substitute authorization certificate will be issued.
When issuing the sub authorization certificate, go into ELIS for the individual and enter in the ROE
Notes section that this initial Substitute Authorization Certificate was "Issued by ROE #3" and include the issue and expiration dates.
If ISP fingerprint criminal background check results are clear, ROE issues a Substitute Authorization Certificate to registrant with signature and seal.
Add Substitute to ROE online database and flag the "Background Check on File" option Provide Copy of Background Report to Applicant.
Regional Office of Education #3 ~ Bond, Fayette, and Effingham Counties Julie Wollerman, Regional Superintendent of Schools
Bill LaDage and Mark Drone, Assistant Regional Superintendents of Schools
300 S. Seventh St., Vandalia, IL 62471 618/283-5011 207 N. Second St. Suite A Greenville, IL 62246 618/664-0121 Fax 618/664-1497
101 N. 4th, Room 204, Effingham, IL 62401 217/342-4363 Fax 217/342-3577
Serving Schools - Protecting Students - Leading for Excellence
To: Substitute Teacher Candidates
From: Julie Wollerman, Regional Superintendent of Schools
RE: Requirements for Substitute Teaching in Bond, Fayette and Effingham Cos.
Here are the requirements for substitute teacher candidates: 1. You must hold a valid Illinois Professional Educator License (PEL) or Educator License
with Stipulations (ELS - substitute license). To apply for either, you must log into ELIS via www.isbe.net and complete an application. Our offices are equipped to help you on-site with this. Please stop in if you need assistance.
a. $100.00 application fee for each license b. $50.00 registration ($10 per year/5 years) fee for the period of validity
Once you have been awarded your license and paid registration fees, you are eligible to substitute teach. However, all schools now require background checks and health papers for you to work in their district. To avoid providing such paperwork (at your cost) to each district, you can obtain an ROE 3 Substitute Teacher Authorization. This allows you to present the paperwork one time to the ROE instead of each district as we are authorized by law to share background checks with districts. The steps for obtaining an ROE 3 Substitute Teacher Authorization are:
2. You must present evidence of a recent medical/physical examination or physician's
authorization of good health (within previous 90 days as per state law 105 ILCS 5/24-5).
3. You must present a valid driver's license or state issued photo ID.
4. You must authorize a fingerprint criminal history check. Our office will provide all the forms that need to be completed. We forward the information to Bushue Human Resources who does the fingerprinting. This will cost the applicant $52.00 and must be paid at the time of fingerprinting. They accept cash, money order, or credit/debit card. Bushue Human Resources is located at 104 North Second Street in Effingham.
5. You must pay a $25 processing fee for issuance of an ROE 3 Substitute Teacher Authorization.
Our office will also ask if you wish to have your name and contact information added to our online substitute teacher database. This is optional. This database is used by our districts when seeking substitute teachers and paraprofessionals. It does not, however, take the place of an individual visit by you. We recommend that you visit each district/school that you have an interest in subbing at and introduce yourself to the administrative staff.
PHYSICIAN’S STATEMENT OF GOOD HEALTH
The * Illinois School Code requires that new employees show evidence of physical fitness to perform duties
assigned to them. Any cost shall rest with the employee.
I hereby certify that _____________________________________________ meets the above
requirement of physical fitness.
Date Signature M.D.
Address
City Zip
Please return to: Regional Office of Education
300 South Seventh Street
Vandalia, IL 62471
Phone: (618) 283-5011
Fax: (618) 283-5013
* (105 ILCS 5/24-5) (from Ch. 122, par. 24-5)
Sec. 24-5. Physical fitness and professional growth.
(a) In this Section, "employee" means any employee of a school district, a student teacher, an employee of a contractor
that provides services to students or in schools, or any other individual subject to the requirements of Section 10-21.9 or 34-
18.5 of this Code.
(b) School boards shall require of new employees evidence of physical fitness to perform duties assigned and freedom
from communicable disease. Such evidence shall consist of a physical examination by a physician licensed in Illinois or any
other state to practice medicine and surgery in all its branches, an advanced practice nurse who has a written collaborative
agreement with a collaborating physician that authorizes the advanced practice nurse to perform health examinations, or a
physician assistant who has been delegated the authority to perform health examinations by his or her supervising physician
not more than 90 days preceding time of presentation to the board, and the cost of such examination shall rest with the
employee. A new or existing employee may be subject to additional health examinations, including screening for tuberculosis,
as required by rules adopted by the Department of Public Health or by order of a local public health official. The board may
from time to time require an examination of any employee by a physician licensed in Illinois to practice medicine and surgery
in all its branches, an advanced practice nurse who has a written collaborative agreement with a collaborating physician that
authorizes the advanced practice nurse to perform health examinations, or a physician assistant who has been delegated the
authority to perform health examinations by his or her supervising physician and shall pay the expenses thereof from school
funds.
(c) School boards may require teachers in their employ to furnish from time to time evidence of continued professional
growth. (Source: P.A. 98-716, eff. 7-16-14.)
FINGERPRINTING - DISCLOSURE AND AUTHORIZATION [IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION]
NOTICE REGARDING BACKGROUND INVESTIGATION
ROE #3 (“the ROE”) may obtain information about you from a consumer reporting agency for purposes of employment, licensure, volunteering, student teaching, or any other contractual services. These reports may contain information regarding your criminal history, motor vehicle records (“driving records”), fingerprint test by state police and/or FBI, or other background checks. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any consumer report. Please be advised that the nature and scope of the most common form of consumer report obtained with regard to applicants, volunteers, and contractors is a fingerprint test and photo recognition by the state police and/or FBI conducted by Bushue Human Resources, Inc., 104 N. Second St., Suite B, Effingham, IL 62401, (217) 342-3042, or toll free at (877) 342-3042, or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing ROE #3 to obtain from any outside organization all manners of consumer reports and investigative consumer reports now and throughout the course of your employment or service to the ROE to the extent permitted by law.
New York applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by ROE #3 by contacting the consumer reporting agency identified above directly.
ACKNOWLEDGMENT AND AUTHORIZATION
I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the ROE at any time after receipt of this authorization and throughout my employment and/or service, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Bushue Human Resources, Inc., 104 N. Second St., Suite B, Effingham, IL 62401, (217) 342-3042, or toll free at (877) 342-3042, another outside organization acting on behalf of ROE #3, and/or the ROE itself. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.
Last Name ______________________________ First __________________________ Middle _________________Maiden/Other Alias______________________
**Social Security # _____________________**Date of Birth _____________Driver’s License # _____________________________ State of Driver’s License ______
Present Address _________________________________________________ City/State/Zip ________________________________________________________
Signature: ________________________________________________Date: ____________________________ Phone___________________________________
**This information will be used for background screening purposes only and will not be used as hiring criteria.
Gender: ____ Male Race: ____ Asian ____Pacific Islander Height:____________
____ Female ____ Black ____White Hispanic Weight: ___________
____ White Place of Birth (State): _________
____ Other
Hair Color: ____ Bald Eye Color: ____ Black Skin Tone: ____ Black
____ Black ____ Blue ____ Dark Brown
____ Blonde ____ Brown ____ Fair
____ Brown ____ Green ____ Light Brown
____ Gray ____ Gray ____ Light
____ Sandy ____ Hazel ____ Medium
____ Red ____ Other ____ Olive
Position: ________________________________________ Please Circle (all that apply): Certified - Non-Certified - Student Teacher - Bus Driver
Per Illinois School Code you are entitled to receive a copy of your criminal background check. Would you like to receive this copy? Yes______ No_______
Office Use Only: Proof of Identity: DL / State I.D. / Passport / Birth Certificate / SSC / Other: __________________ ORI #: IL003E03S or SB0261004
Technician: ______________________________ Technician License #: 249.0000 TCN:_______________________________________
Date of Fingerprinting:________________________ Time:________________________ Location:_______________________________________
Regional Office of Education #3 ~ Bond, Fayette, and Effingham Counties Julie Wollerman, Regional Superintendent of Schools
Bill LaDage and Mark Drone, Assistant Regional Superintendents of Schools
300 S. Seventh St., Vandalia, IL 62471 618/283-5011 207 N. Second St. Suite A Greenville, IL 62246 618/664-0121 Fax 618/664-1497
101 N. 4th, Room 204, Effingham, IL 62401 217/342-4363 Fax 217/342-3577
Serving Schools - Protecting Students - Leading for Excellence
SUBSTITUTE TEACHER AUTHORIZATION FORM
Section 10‐21.9 of Illinois School Code requires all applicants for employment with a school district including persons who or firms holding contracts with the district, who have direct daily contact with the pupils of any district school, to authorize a fingerprint‐based criminal history records check to determine if the applicant has been convicted of certain enumerated offenses, and a check of criminal databases. A school board shall not knowingly employ a person for whom a criminal background investigation has not been initiated. I authorize the Regional Office of Education for Bond, Fayette and Effingham Counties to submit fingerprints and other necessary information electronically to the Illinois State Police (ISP) and the Federal Bureau of Investigation (FBI) via Bushue Human Resource, Inc. to conduct a criminal background check. I further authorize the Regional Office of Education for Bond, Fayette and Effingham Counties to check for my name on the Statewide Illinois Sex Offender Database. I further authorize the Regional Office of Education for Bond, Fayette and Effingham Counties to check for my name on the Illinois Statewide Child Murderer and Violent Offenders Against Youth Database. I understand that conviction on any of the enumerated offenses or the presence of your name on any of these reports will exclude me from substitute teaching in Bond, Fayette and Effingham schools and could result in the suspension, revocation, or surrender of my teaching certificate(s). I understand that the Regional Superintendent shall share criminal history reports with the Superintendent of a School District, other Regional Superintendents, the State Superintendent of Schools, and the State Teacher Certification Board. I further understand that a copy of the criminal history check shall be provided to me if requested. I understand that I am responsible for the payment of the cost of the criminal history check and checks of the Statewide Sex Offender Database and Statewide Child Murderer and Violent Offender Against Youth Database. I understand that receiving a Substitute Authorization Certificate is necessary to substitute teach in Public Schools of Bond, Fayette and Effingham Counties, and that obtaining such certificate does not guarantee that I will be hired as a substitute teacher in Bond, Fayette and Effingham Counties.
Name (Please Print) Date
Signature IEIN or SS #
Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la
Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006.
A Summary of Your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of
information in the files of consumer reporting agencies. There are many types of consumer
reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell
information about check writing histories, medical records, and rental history records). Here is a
summary of your major rights under the FCRA. For more information, including information
about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer
Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006.
• You must be told if information in your file has been used against you. Anyone who uses a
credit report or another type of consumer report to deny your application for credit, insurance, or
employment – or to take another adverse action against you – must tell you, and must give you
the name, address, and phone number of the agency that provided the information.
• You have the right to know what is in your file. You may request and obtain all the
information about you in the files of a consumer reporting agency (your “file disclosure”). You
will be required to provide proper identification, which may include your Social Security
number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
• a person has taken adverse action against you because of information in your credit report;
• you are the victim of identify theft and place a fraud alert in your file;
• your file contains inaccurate information as a result of fraud;
• you are on public assistance;
• you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers are entitled to one free disclosure every 12 months upon request from
each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See
www.consumerfinance.gov/learnmore for additional information.
• You have the right to ask for a credit score. Credit scores are numerical summaries of your
credit-worthiness based on information from credit bureaus. You may request a credit score
from consumer reporting agencies that create scores or distribute scores used in residential real
property loans, but you will have to pay for it. In some mortgage transactions, you will receive
credit score information for free from the mortgage lender.
• You have the right to dispute incomplete or inaccurate information. If you identify
information in your file that is incomplete or inaccurate, and report it to the consumer
reporting agency, the agency must investigate unless your dispute is frivolous. See
www.consumerfinance.gov/learnmore for an explanation of dispute procedures.
• Consumer reporting agencies must correct or delete inaccurate, incomplete, or
unverifiable information. Inaccurate, incomplete or unverifiable information must be removed
or corrected, usually within 30 days. However, a consumer reporting agency may continue to
report information it has verified as accurate.
• Consumer reporting agencies may not report outdated negative information. In most
cases, a consumer reporting agency may not report negative information that is more than seven
years old, or bankruptcies that are more than 10 years old.
• Access to your file is limited. A consumer reporting agency may provide information about
you only to people with a valid need – usually to consider an application with a creditor, insurer,
employer, landlord, or other business. The FCRA specifies those with a valid need for access.
• You must give your consent for reports to be provided to employers. A consumer reporting
agency may not give out information about you to your employer, or a potential employer,
without your written consent given to the employer. Written consent generally is not required in
the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.
• You may limit “prescreened” offers of credit and insurance you get based on information
in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a
toll-free phone number you can call if you choose to remove your name and address from the
lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-
8688.
• You may seek damages from violators. If a consumer reporting agency, or, in some cases, a
user of consumer reports or a furnisher of information to a consumer reporting agency violates
the FCRA, you may be able to sue in state or federal court.
• Identity theft victims and active duty military personnel have additional rights. For more
information, visit www.consumerfinance.gov/learnmore.
States may enforce the FCRA, and many states have their own consumer reporting laws.
In some cases, you may have more rights under state law. For more information, contact
your state or local consumer protection agency or your state Attorney General. For
information about your federal rights, contact:
TYPE OF BUSINESS: CONTACT: 1.a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates. b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the Bureau:
a. Bureau of Consumer Financial Protection 1700 G Street NW Washington, DC 20006 b. Federal Trade Commission: Consumer Response Center – FCRA Washington, DC 20580 (877) 382-4357
2. To the extent not included in item 1 above: a. National banks, federal savings associations, and federal branches and federal agencies of foreign banks b. State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and insured state branches of foreign banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations d. Federal Credit Unions
a. Office of the Comptroller of the Currency Customer Assistance Group 1301 McKinney Street, Suite 3450 Houston, TX 77010-9050 b. Federal Reserve Consumer Help Center P.O. Box 1200 Minneapolis, MN 55480 c. FDIC Consumer Response Center 1100 Walnut Street, Box #11 Kansas City, MO 64106 d. National Credit Union Administration Office of Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO) 1775 Duke Street Alexandria, VA 22314
3. Air carriers Asst. General Counsel for Aviation Enforcement & Proceedings Department of Transportation 400 Seventh Street SW Washington, DC 20590
4. Creditors Subject to Surface Transportation Board Office of Proceedings, Surface Transportation Board Department of Transportation 1925 K Street NW Washington, DC 20423
5. Creditors Subject to Packers and Stockyards Act Nearest Packers and Stockyards Administration area supervisor
6. Small Business Investment Companies Associate Deputy Administrator for Capital Access United States Small Business Administration 406 Third Street, SW, 8th Floor Washington, DC 20416
7. Brokers and Dealers Securities and Exchange Commission 100 F St NE Washington, DC 20549
8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations
Farm Credit Administration 1501 Farm Credit Drive McLean, VA 22102-5090
9. Retailers, Finance Companies, and All Other Creditors Not Listed Above
FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center – FCRA Washington, DC 20580 (877) 382-4357
A Division of Bushue Human Resources, Inc.
Bushue Background Screening is the fingerprinting/background
screening provider for Regional Office of Education #3
A fingerprint criminal check is a requirement by the Illinois School Code. Background checks are conducted through the submission of fingerprints to the Illinois State Police and FBI. Due to the new school code that went into effect January 1, 2011, all substitute teachers are responsible for the payment of fees for their fingerprinting and criminal background check. Payment is to be made directly to Bushue Background Screening at the time your fingerprints are taken. The fee is $52 and is payable with cash, money order, or credit/debit cards. NO PERSONAL CHECKS WILL BE ACCEPTED.
To schedule an appointment to be fingerprinted, please call our office
at 217-342-3042
Office Hours: M-F 8:00-5:00
Please bring valid driver’s license on the day your prints are to be conducted.
Substitute Teacher Preference Form Bond-Fayette-Effingham
Regional Office of Education #3: Bond – Fayette -- Effingham
Name: Home Telephone: Cell Phone:
Address: City: Social Security No.
Please specify your school preferences by checking the boxes next to the schools
Bond County Schools
Mulberry Grove High School
Mulberry Grove Jr. High School
Mulberry Grove Elementary School
Bond Co. (Greenville) High School
Greenville Jr. High School
Greenville Elementary School
Pocahontas Elementary School
Sorento Elementary School
Fayette County Schools
Brownstown Jr./Sr. High School
Brownstown Elementary School
St. Elmo High School
St. Elmo Jr. High School
St. Elmo Elementary School
Vandalia High School
Okaw Area Vocational Center
Vandalia Jr. High School
Vandalia Elementary School
Jefferson Primary School
Ramsey High School
Ramsey Elementary School
ROE #3 Alternative Education Programs (Vandalia)
Effingham County Schools
Altamont High School
Altamont Elementary School
Beecher City Jr/Sr High School
Beecher City Elementary School
Dieterich Jr/Sr High School
Dieterich Elementary School
Teutopolis High School
Teutopolis Jr High School
Teutopolis Elementary School
Effingham High School
Effingham Jr. High School
Effingham Central Grade School
South Side Grade School
Early Learning Center
ROE #3 Alternative Education Programs (Effingham)
Other Schools
Altamont Lutheran School
St Peter’s Lutheran School
Vandalia Christian Academy
South Central High School
Sacred Heart Elementary School (Eff.)
St. Anthony High School (Eff.)
St. Anthony Grade School (Eff.)
Substitute Teacher Preference Form Bond-Fayette-Effingham
Regional Office of Education #3: Bond – Fayette -- Effingham
Please specify your grade level preferences by checking all grade levels that apply:
Grade Levels Preferred: Pre-K or K Grade 1 Grade 2 Grade 3 Grade 4
Grade 5 Grade 6 Grade 7 Grade 8 Grade 9
Grade 10 Grade 11 Grade 12
Please specify your subject area preferences by checking all subject areas that apply:
Subjects Preferred: Mathematics Science Social Studies P.E. Health
Music Art Technology Special Ed Reading
Language Arts Speech Vocational Business Home Econ.
Other Please Specify:
Please indicate any other preferences or criteria that you would like made available to prospective employers:
Name of Registrant: _____________________________________ Date: _______________
Substitute Teacher Registration Checklist
NOTE: The cost of substitute authorization is $25.00
___________ Check ELIS for existing credentials IEIN:
Make photocopy of State-issued photo I.D. (e.g., valid driver’s license) Evidence of recent medical/physical examination or physician's authorization of good health
(within previous 90 days as per 105 iLCS 5/24-5) (Give applicant a copy of the Physician's Statement of Good Health Form)
[If needed] Download a Physician's Statement of Good Health Form, have it completed by a
physician and submit it with your paperwork.
Fingerprint Criminal Background Check:
Registrant must read and sign Disclosure and Authorization form and submit to ROE.
Registrant must read and sign Substitute Teacher Authorization Form.
Registrant must be given A Summary of Your Rights Under the Fair Credit Reporting Act.
Tell the registrant that this is not a credit history check. It is simply required by the Federal Trade Commission.
appointment scheduling form and gives form to registrant
ROE fills out Bushue Background Screening
ROE logs into Bushue Human Resources web page and creates New Order with registrant information. See Bushue HR Guide for details.
ROE fills out Background Check Request form and FAXes the following two documents to
Bushue HR at (217)342-5653: Background Check Request Form Disclosure and Authorization Form
[OPTIONAL] Substitute fills out Substitute Preference Form and submits to ROE
ROE registrar logs into BushueHR Web Site and Check Reports.
Next page
Print out and save the following:
Statewide Sex Offender Database Check and Statewide Child Murderer and Violent Offender Against Youth Database Check
Illinois State Police will send fingerprint criminal background check results to Regional Superintendent. Regional Superintendent reviews and determines if a substitute authorization certificate will be issued.
When issuing the sub authorization certificate, go into ELIS for the individual and enter in the ROE
Notes section that this initial Substitute Authorization Certificate was "Issued by ROE #3" and include the issue and expiration dates.
If ISP fingerprint criminal background check results are clear, ROE issues a Substitute Authorization Certificate to registrant with signature and seal.
Add Substitute to ROE online database and flag the "Background Check on File" option Provide Copy of Background Report to Applicant.
Regional Office of Education #3 ~ Bond, Fayette, and Effingham Counties Julie Wollerman, Regional Superintendent of Schools
Bill LaDage and Mark Drone, Assistant Regional Superintendents of Schools
300 S. Seventh St., Vandalia, IL 62471 618/283-5011 207 N. Second St. Suite A Greenville, IL 62246 618/664-0121 Fax 618/664-1497
101 N. 4th, Room 204, Effingham, IL 62401 217/342-4363 Fax 217/342-3577
Serving Schools - Protecting Students - Leading for Excellence
To: Substitute Teacher Candidates
From: Julie Wollerman, Regional Superintendent of Schools
RE: Requirements for Substitute Teaching in Bond, Fayette and Effingham Cos.
Here are the requirements for substitute teacher candidates: 1. You must hold a valid Illinois Professional Educator License (PEL) or Educator License
with Stipulations (ELS - substitute license). To apply for either, you must log into ELIS via www.isbe.net and complete an application. Our offices are equipped to help you on-site with this. Please stop in if you need assistance.
a. $100.00 application fee for each license b. $50.00 registration ($10 per year/5 years) fee for the period of validity
Once you have been awarded your license and paid registration fees, you are eligible to substitute teach. However, all schools now require background checks and health papers for you to work in their district. To avoid providing such paperwork (at your cost) to each district, you can obtain an ROE 3 Substitute Teacher Authorization. This allows you to present the paperwork one time to the ROE instead of each district as we are authorized by law to share background checks with districts. The steps for obtaining an ROE 3 Substitute Teacher Authorization are:
2. You must present evidence of a recent medical/physical examination or physician's
authorization of good health (within previous 90 days as per state law 105 ILCS 5/24-5).
3. You must present a valid driver's license or state issued photo ID.
4. You must authorize a fingerprint criminal history check. Our office will provide all the forms that need to be completed. We forward the information to Bushue Human Resources who does the fingerprinting. This will cost the applicant $52.00 and must be paid at the time of fingerprinting. They accept cash, money order, or credit/debit card. Bushue Human Resources is located at 104 North Second Street in Effingham.
5. You must pay a $25 processing fee for issuance of an ROE 3 Substitute Teacher Authorization.
Our office will also ask if you wish to have your name and contact information added to our online substitute teacher database. This is optional. This database is used by our districts when seeking substitute teachers and paraprofessionals. It does not, however, take the place of an individual visit by you. We recommend that you visit each district/school that you have an interest in subbing at and introduce yourself to the administrative staff.
PHYSICIAN’S STATEMENT OF GOOD HEALTH
The * Illinois School Code requires that new employees show evidence of physical fitness to perform duties
assigned to them. Any cost shall rest with the employee.
I hereby certify that _____________________________________________ meets the above
requirement of physical fitness.
Date Signature M.D.
Address
City Zip
Please return to: Regional Office of Education
300 South Seventh Street
Vandalia, IL 62471
Phone: (618) 283-5011
Fax: (618) 283-5013
* (105 ILCS 5/24-5) (from Ch. 122, par. 24-5)
Sec. 24-5. Physical fitness and professional growth.
(a) In this Section, "employee" means any employee of a school district, a student teacher, an employee of a contractor
that provides services to students or in schools, or any other individual subject to the requirements of Section 10-21.9 or 34-
18.5 of this Code.
(b) School boards shall require of new employees evidence of physical fitness to perform duties assigned and freedom
from communicable disease. Such evidence shall consist of a physical examination by a physician licensed in Illinois or any
other state to practice medicine and surgery in all its branches, an advanced practice nurse who has a written collaborative
agreement with a collaborating physician that authorizes the advanced practice nurse to perform health examinations, or a
physician assistant who has been delegated the authority to perform health examinations by his or her supervising physician
not more than 90 days preceding time of presentation to the board, and the cost of such examination shall rest with the
employee. A new or existing employee may be subject to additional health examinations, including screening for tuberculosis,
as required by rules adopted by the Department of Public Health or by order of a local public health official. The board may
from time to time require an examination of any employee by a physician licensed in Illinois to practice medicine and surgery
in all its branches, an advanced practice nurse who has a written collaborative agreement with a collaborating physician that
authorizes the advanced practice nurse to perform health examinations, or a physician assistant who has been delegated the
authority to perform health examinations by his or her supervising physician and shall pay the expenses thereof from school
funds.
(c) School boards may require teachers in their employ to furnish from time to time evidence of continued professional
growth. (Source: P.A. 98-716, eff. 7-16-14.)
FINGERPRINTING - DISCLOSURE AND AUTHORIZATION [IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION]
NOTICE REGARDING BACKGROUND INVESTIGATION
ROE #3 (“the ROE”) may obtain information about you from a consumer reporting agency for purposes of employment, licensure, volunteering, student teaching, or any other contractual services. These reports may contain information regarding your criminal history, motor vehicle records (“driving records”), fingerprint test by state police and/or FBI, or other background checks. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any consumer report. Please be advised that the nature and scope of the most common form of consumer report obtained with regard to applicants, volunteers, and contractors is a fingerprint test and photo recognition by the state police and/or FBI conducted by Bushue Human Resources, Inc., 104 N. Second St., Suite B, Effingham, IL 62401, (217) 342-3042, or toll free at (877) 342-3042, or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing ROE #3 to obtain from any outside organization all manners of consumer reports and investigative consumer reports now and throughout the course of your employment or service to the ROE to the extent permitted by law.
New York applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by ROE #3 by contacting the consumer reporting agency identified above directly.
ACKNOWLEDGMENT AND AUTHORIZATION
I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the ROE at any time after receipt of this authorization and throughout my employment and/or service, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Bushue Human Resources, Inc., 104 N. Second St., Suite B, Effingham, IL 62401, (217) 342-3042, or toll free at (877) 342-3042, another outside organization acting on behalf of ROE #3, and/or the ROE itself. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.
Last Name ______________________________ First __________________________ Middle _________________Maiden/Other Alias______________________
**Social Security # _____________________**Date of Birth _____________Driver’s License # _____________________________ State of Driver’s License ______
Present Address _________________________________________________ City/State/Zip ________________________________________________________
Signature: ________________________________________________Date: ____________________________ Phone___________________________________
**This information will be used for background screening purposes only and will not be used as hiring criteria.
Gender: ____ Male Race: ____ Asian ____Pacific Islander Height:____________
____ Female ____ Black ____White Hispanic Weight: ___________
____ White Place of Birth (State): _________
____ Other
Hair Color: ____ Bald Eye Color: ____ Black Skin Tone: ____ Black
____ Black ____ Blue ____ Dark Brown
____ Blonde ____ Brown ____ Fair
____ Brown ____ Green ____ Light Brown
____ Gray ____ Gray ____ Light
____ Sandy ____ Hazel ____ Medium
____ Red ____ Other ____ Olive
Position: ________________________________________ Please Circle (all that apply): Certified - Non-Certified - Student Teacher - Bus Driver
Per Illinois School Code you are entitled to receive a copy of your criminal background check. Would you like to receive this copy? Yes______ No_______
Office Use Only: Proof of Identity: DL / State I.D. / Passport / Birth Certificate / SSC / Other: __________________ ORI #: IL003E03S or SB0261004
Technician: ______________________________ Technician License #: 249.0000 TCN:_______________________________________
Date of Fingerprinting:________________________ Time:________________________ Location:_______________________________________
Regional Office of Education #3 ~ Bond, Fayette, and Effingham Counties Julie Wollerman, Regional Superintendent of Schools
Bill LaDage and Mark Drone, Assistant Regional Superintendents of Schools
300 S. Seventh St., Vandalia, IL 62471 618/283-5011 207 N. Second St. Suite A Greenville, IL 62246 618/664-0121 Fax 618/664-1497
101 N. 4th, Room 204, Effingham, IL 62401 217/342-4363 Fax 217/342-3577
Serving Schools - Protecting Students - Leading for Excellence
SUBSTITUTE TEACHER AUTHORIZATION FORM
Section 10‐21.9 of Illinois School Code requires all applicants for employment with a school district including persons who or firms holding contracts with the district, who have direct daily contact with the pupils of any district school, to authorize a fingerprint‐based criminal history records check to determine if the applicant has been convicted of certain enumerated offenses, and a check of criminal databases. A school board shall not knowingly employ a person for whom a criminal background investigation has not been initiated. I authorize the Regional Office of Education for Bond, Fayette and Effingham Counties to submit fingerprints and other necessary information electronically to the Illinois State Police (ISP) and the Federal Bureau of Investigation (FBI) via Bushue Human Resource, Inc. to conduct a criminal background check. I further authorize the Regional Office of Education for Bond, Fayette and Effingham Counties to check for my name on the Statewide Illinois Sex Offender Database. I further authorize the Regional Office of Education for Bond, Fayette and Effingham Counties to check for my name on the Illinois Statewide Child Murderer and Violent Offenders Against Youth Database. I understand that conviction on any of the enumerated offenses or the presence of your name on any of these reports will exclude me from substitute teaching in Bond, Fayette and Effingham schools and could result in the suspension, revocation, or surrender of my teaching certificate(s). I understand that the Regional Superintendent shall share criminal history reports with the Superintendent of a School District, other Regional Superintendents, the State Superintendent of Schools, and the State Teacher Certification Board. I further understand that a copy of the criminal history check shall be provided to me if requested. I understand that I am responsible for the payment of the cost of the criminal history check and checks of the Statewide Sex Offender Database and Statewide Child Murderer and Violent Offender Against Youth Database. I understand that receiving a Substitute Authorization Certificate is necessary to substitute teach in Public Schools of Bond, Fayette and Effingham Counties, and that obtaining such certificate does not guarantee that I will be hired as a substitute teacher in Bond, Fayette and Effingham Counties.
Name (Please Print) Date
Signature IEIN or SS #
Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la
Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006.
A Summary of Your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of
information in the files of consumer reporting agencies. There are many types of consumer
reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell
information about check writing histories, medical records, and rental history records). Here is a
summary of your major rights under the FCRA. For more information, including information
about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer
Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006.
• You must be told if information in your file has been used against you. Anyone who uses a
credit report or another type of consumer report to deny your application for credit, insurance, or
employment – or to take another adverse action against you – must tell you, and must give you
the name, address, and phone number of the agency that provided the information.
• You have the right to know what is in your file. You may request and obtain all the
information about you in the files of a consumer reporting agency (your “file disclosure”). You
will be required to provide proper identification, which may include your Social Security
number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
• a person has taken adverse action against you because of information in your credit report;
• you are the victim of identify theft and place a fraud alert in your file;
• your file contains inaccurate information as a result of fraud;
• you are on public assistance;
• you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers are entitled to one free disclosure every 12 months upon request from
each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See
www.consumerfinance.gov/learnmore for additional information.
• You have the right to ask for a credit score. Credit scores are numerical summaries of your
credit-worthiness based on information from credit bureaus. You may request a credit score
from consumer reporting agencies that create scores or distribute scores used in residential real
property loans, but you will have to pay for it. In some mortgage transactions, you will receive
credit score information for free from the mortgage lender.
• You have the right to dispute incomplete or inaccurate information. If you identify
information in your file that is incomplete or inaccurate, and report it to the consumer
reporting agency, the agency must investigate unless your dispute is frivolous. See
www.consumerfinance.gov/learnmore for an explanation of dispute procedures.
• Consumer reporting agencies must correct or delete inaccurate, incomplete, or
unverifiable information. Inaccurate, incomplete or unverifiable information must be removed
or corrected, usually within 30 days. However, a consumer reporting agency may continue to
report information it has verified as accurate.
• Consumer reporting agencies may not report outdated negative information. In most
cases, a consumer reporting agency may not report negative information that is more than seven
years old, or bankruptcies that are more than 10 years old.
• Access to your file is limited. A consumer reporting agency may provide information about
you only to people with a valid need – usually to consider an application with a creditor, insurer,
employer, landlord, or other business. The FCRA specifies those with a valid need for access.
• You must give your consent for reports to be provided to employers. A consumer reporting
agency may not give out information about you to your employer, or a potential employer,
without your written consent given to the employer. Written consent generally is not required in
the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.
• You may limit “prescreened” offers of credit and insurance you get based on information
in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a
toll-free phone number you can call if you choose to remove your name and address from the
lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-
8688.
• You may seek damages from violators. If a consumer reporting agency, or, in some cases, a
user of consumer reports or a furnisher of information to a consumer reporting agency violates
the FCRA, you may be able to sue in state or federal court.
• Identity theft victims and active duty military personnel have additional rights. For more
information, visit www.consumerfinance.gov/learnmore.
States may enforce the FCRA, and many states have their own consumer reporting laws.
In some cases, you may have more rights under state law. For more information, contact
your state or local consumer protection agency or your state Attorney General. For
information about your federal rights, contact:
TYPE OF BUSINESS: CONTACT: 1.a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates. b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the Bureau:
a. Bureau of Consumer Financial Protection 1700 G Street NW Washington, DC 20006 b. Federal Trade Commission: Consumer Response Center – FCRA Washington, DC 20580 (877) 382-4357
2. To the extent not included in item 1 above: a. National banks, federal savings associations, and federal branches and federal agencies of foreign banks b. State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and insured state branches of foreign banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations d. Federal Credit Unions
a. Office of the Comptroller of the Currency Customer Assistance Group 1301 McKinney Street, Suite 3450 Houston, TX 77010-9050 b. Federal Reserve Consumer Help Center P.O. Box 1200 Minneapolis, MN 55480 c. FDIC Consumer Response Center 1100 Walnut Street, Box #11 Kansas City, MO 64106 d. National Credit Union Administration Office of Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO) 1775 Duke Street Alexandria, VA 22314
3. Air carriers Asst. General Counsel for Aviation Enforcement & Proceedings Department of Transportation 400 Seventh Street SW Washington, DC 20590
4. Creditors Subject to Surface Transportation Board Office of Proceedings, Surface Transportation Board Department of Transportation 1925 K Street NW Washington, DC 20423
5. Creditors Subject to Packers and Stockyards Act Nearest Packers and Stockyards Administration area supervisor
6. Small Business Investment Companies Associate Deputy Administrator for Capital Access United States Small Business Administration 406 Third Street, SW, 8th Floor Washington, DC 20416
7. Brokers and Dealers Securities and Exchange Commission 100 F St NE Washington, DC 20549
8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations
Farm Credit Administration 1501 Farm Credit Drive McLean, VA 22102-5090
9. Retailers, Finance Companies, and All Other Creditors Not Listed Above
FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center – FCRA Washington, DC 20580 (877) 382-4357
A Division of Bushue Human Resources, Inc.
Bushue Background Screening is the fingerprinting/background
screening provider for Regional Office of Education #3
A fingerprint criminal check is a requirement by the Illinois School Code. Background checks are conducted through the submission of fingerprints to the Illinois State Police and FBI. Due to the new school code that went into effect January 1, 2011, all substitute teachers are responsible for the payment of fees for their fingerprinting and criminal background check. Payment is to be made directly to Bushue Background Screening at the time your fingerprints are taken. The fee is $52 and is payable with cash, money order, or credit/debit cards. NO PERSONAL CHECKS WILL BE ACCEPTED.
To schedule an appointment to be fingerprinted, please call our office
at 217-342-3042
Office Hours: M-F 8:00-5:00
Please bring valid driver’s license on the day your prints are to be conducted.
B A C K G R O U N D C H E C K R E Q U E S T
COVER SHEET
TO: FROM:
Bushue Human Resources, Inc. ROE #3
FAX NUMBER: DATE:
217-342-5653 PHONE NUMBER: TOTAL NO. OF PAGES INCLUDING COVER:
217-342-3042 RE: EMPLOYEE/APPLICANT NAME:
Background Check Request Services to Provide: Please indicate in the boxes below the background check(s) you are requesting:
School District Employee (certified employee) State and Federal Fingerprint Background Check State and Federal Sex Offender Check Violent Offender Against Youth Database
School District Employee (non-certified employee) State and Federal Fingerprint Background Check State and Federal Sex Offender Check Violent Offender Against Youth Database Student Teacher (non-certified employee) State and Federal Fingerprint Background Check State and Federal Sex Offender Check Violent Offender Against Youth Database School District Bus Driver State and Federal Fingerprint Background Check State and Federal Sex Offender Check Violent Offender Against Youth Database Motor Vehicle Record Check Volunteer Background Check (non-fingerprint) State and Federal Sex Offender Check Violent Offender Against Youth Database
I, _________________________________________, (print name) authorize Bushue Human Resources, Inc. to conduct the requested background check and return the results to ROE #3. ____________________________________________ _______________________ Signature of Requesting District Employee Date
Substitute Teacher Preference Form Bond-Fayette-Effingham
Regional Office of Education #3: Bond – Fayette -- Effingham
Name: Home Telephone: Cell Phone:
Address: City: Social Security No.
Please specify your school preferences by checking the boxes next to the schools
Bond County Schools
Mulberry Grove High School
Mulberry Grove Jr. High School
Mulberry Grove Elementary School
Bond Co. (Greenville) High School
Greenville Jr. High School
Greenville Elementary School
Pocahontas Elementary School
Sorento Elementary School
Fayette County Schools
Brownstown Jr./Sr. High School
Brownstown Elementary School
St. Elmo High School
St. Elmo Jr. High School
St. Elmo Elementary School
Vandalia High School
Okaw Area Vocational Center
Vandalia Jr. High School
Vandalia Elementary School
Jefferson Primary School
Ramsey High School
Ramsey Elementary School
ROE #3 Alternative Education Programs (Vandalia)
Effingham County Schools
Altamont High School
Altamont Elementary School
Beecher City Jr/Sr High School
Beecher City Elementary School
Shumway Elementary School
Dieterich Jr/Sr High School
Dieterich Elementary School
Teutopolis High School
Teutopolis Jr High School
Teutopolis Elementary School
Effingham High School
Effingham Jr. High School
Effingham Central Grade School
South Side Grade School
Early Learning Center
ROE #3 Alternative Education Programs (Effingham)
Other Schools
Altamont Lutheran School
St Peter’s Lutheran School
Vandalia Christian Academy
South Central High School
Sacred Heart Elementary School (Eff.)
St. Anthony High School (Eff.)
St. Anthony Grade School (Eff.)
Substitute Teacher Preference Form Bond-Fayette-Effingham
Regional Office of Education #3: Bond – Fayette -- Effingham
Please specify your grade level preferences by checking all grade levels that apply:
Grade Levels Preferred: Pre-K or K Grade 1 Grade 2 Grade 3 Grade 4
Grade 5 Grade 6 Grade 7 Grade 8 Grade 9
Grade 10 Grade 11 Grade 12
Please specify your subject area preferences by checking all subject areas that apply:
Subjects Preferred: Mathematics Science Social Studies P.E. Health
Music Art Technology Special Ed Reading
Language Arts Speech Vocational Business Home Econ.
Other Please Specify:
Please indicate any other preferences or criteria that you would like made available to prospective employers: