TO:

MEDINA CITY SCHOOL DISTRICT 739 WEYMOUTH ROAD MEDINA OH 44256

Date _______________

Attn: Debra Nelsen, Human Resources

SUBSTITUTE PREFERENCES & AVAILABILITY I am interested in substituting in the following Support Staff job categories for Medina City School District:

_____ Custodian (Much of this work is 2nd shift, 3:00-11:30 p.m.) _____ Secretary (Strong customer service skills and computer proficiency is preferred.) _____ Food Service - Cook, Server (generally late morning to early afternoon, 2.5 to 6.0 hours) _____ Instructional Paraprofessional - Teacher/Media Aide (May include crossing guard duties) _____ Teacher Aide (Special Education) (May include crossing guard duties) _____ Bus Driver (Must contact Transportation Coordinator)

Time Available & Additional Comments: _____________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

Please Print Name:

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Address:

_________________________________________________ _________________________________________________

Telephone:

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Last six digits of Social Security Number: E-mail Address:

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****************************************************************************************** OFFICE USE ONLY:

_____ Application _____ Background Check _____ I-9 Form