Doe Ohr 600 004 Form – Fill Out and Use This PDF

Form DOE OHR 600-004 at a glance

What it is: Form DOE OHR 600-004, the Substitute Teacher Application and Renewal, is a form of the Department of Education, Office of Human Resources.

Who signs: Sign on the Applicant's Signature line and write the Date (MM/DD/YYYY).

A filled-in Form DOE OHR 600-004 example: a new substitute teacher fills in Section I

How to fill out Form DOE OHR 600-004, box by box

Mark one: New Application or Annual Renewal

Mark one: New Application* or Annual Renewal, and for Annual Renewal write the School Year. *Valid documentation showing your ability to legally work in the United States may be required (i.e., Employment Authorization Document, Permanent Resident Card, unexpired foreign passport, etc.).

I. EMPLOYEE / APPLICANT INFORMATION

In Section I, write your Name (Last, First, M.I.), the Last 4 digits of SSN and your Mailing Address (Required).

Write the City, State, Zip and Permanent Tel#.

Mark one Mailing Preference, USPS Mail or E-Mail; if E-Mail, please provide the e-mail.

Mark if applicable

Mark Change in Permanent Tel# if applicable; the Permanent Tel# is in Section I.

Mark Change in Preferences, then read and complete Section IV, as applicable.

Mark Classification Change: write the Class and the Class it changes to, and attach official transcripts, copy of teaching lic. and/or grade rpts.

Mark District Transfer: write the Effective Date and the District you transfer from.

Signing the application

"I hereby certify that all statements in this application are true, complete and correct."

"I understand that any willful omission or falsification of material facts in this application or breach of the Application Agreement will constitute sufficient reason for immediate dismissal."

The Complex Area Superintendent or Designee's Signature, Acceptance (Today's Date) and Effective Date of Form 5 for the form's acceptance: "I hereby accept this applicant to be a substitute teacher in the District for the current school year."

More rules for Form DOE OHR 600-004

You are restricted to teaching in only one (1) home district; mark it: HON, CEN, LEE, WIN, HAW or MAUI, KAU or Public Charter Schools.

Write the Name of School if you are on at least one school priority list.

The Principal/Designee Signature, Date, Principal/Designee Name (Print) and Title go under SIGN.

Write the Exact date completed (MM/DD/YYYY) and the Location/Channel Viewed for the annual Bloodborne Training requirement, completed within ONE (1) YEAR of the date on this application.

For the 30-Hour Substitute Teacher Course, mark Yes and write the Date and Location, or mark No and write the Anticipated Completion Date.

For the Re-Certification Class, mark Yes and write the Date and Location, or mark No and write the Anticipated Completion Date. Class I and Class II substitutes must have completed the 30-hour Substitute Teacher Course before taking the Re-Certification Class.

In PERSONAL DATA, 1. Have you at any time been suspended, fired, terminated, dismissed, discharged or asked to resign from employment. If yes, please explain.

2. Have you at any time separated from military service under conditions other than honorable. If yes, please explain.

3. Have you at any time been arrested and/or convicted. If arrested, please specify what you were arrested for; if arrested, were you charged? If charged, please specify what you were charged with and the disposition (outcome) of the charge.

4. Have you at any time had a professional license or certification (for example, attorney, nurse, psychologist, teacher, school administrator, etc.) suspended, revoked, denied or not renewed. If yes, please explain.

Conviction or termination from employment will not necessarily disqualify an applicant.

New Applicants: please complete Section III. Existing substitute teachers: please complete only if there are any changes to your educational and professional training record.

List your degree(s) and the college and/or university at which the degree(s) was earned. The information should be complete and the official college and/or university transcript showing degree(s) granted and/or credits earned must be submitted.

Timely transcript submittal is required to verify your proper classification and certification status since this may affect your assigned pay rate and priority for day-to-day employment.

Transcripts submitted become the property of the Hawaii State Department of Education and will not be returned to applicant.

For each degree, write the Degree, Date, Major, College/University, Location (City/State), From, To and Sem. Hrs.

For Student Teaching and/or Intern Teaching, write From, To, Subject/Grade Level, Name and Address of School, Name of Cooperating Teacher and Sem. Hrs.

Under Professional Certification, write the Type of Teaching Certificate, State, Date Issued and Expiration Date.

Under Professional Experience in Hawaii, list your most recent experience, if any: Name of School, Location (City/State), Grade/Subject, From, To, Type of Employment (Contract or Substitute) and Reason for Leaving.

Class I substitute teachers: the T-SEAS computer will only call you for jobs at your priority schools. DO NOT complete Section IVa.- IVc.

Class II & Class III substitute teachers: if you DO NOT want the T-SEAS computer to call you, go directly to Section IVd. - SPECIAL PREFERENCES and check the box marked "PRE-ARRANGED ASSIGNMENTS ONLY."

Offers from T-SEAS will be restricted to your priority list(s) and the complex areas and grade levels you select. Your subject preferences will also be considered, however, there may be days when you are needed for subjects you have not selected.

Based on the ONE (1) Home District you selected in Section II., mark the corresponding complexes where you are willing and able to work. You are restricted to teaching in your Home District only and cannot select complexes in other districts.

Mark the grade level codes you are willing and able to teach.

Mark the subject area codes you are willing and able to teach.

By marking PRE-ARRANGED ASSIGNMENTS ONLY, you are choosing to ONLY accept assignments offered directly by schools or teachers. You will not be contacted by the T-SEAS computer (DO NOT select codes if you choose this option).

SUBSTITUTES ON OAHU ONLY: assignments at the Hawaii School for the Deaf and the Blind (HSDB). Your name will be forwarded to HSDB; if you are needed, you will be contacted directly. Mark YES or NO for communicating in ASL at a proficiency rate of 50% or higher; if yes, write what percentage.

Please read the following statements, then sign to indicate understanding and acceptance. If you need clarification about any statement, check with your school administrator or Personnel Regional Officer.

I have read and attached a signed copy of the "Hawaii State Department of Education Acknowledgement of General Confidentiality Expectations".

Common questions about Form DOE OHR 600-004

Sources

[1] Form DOE OHR 600-004 (Last Revised 06/27/2012), Substitute Teacher Application and Renewal, Department of Education, Office of Human Resources (the Official source link on this page).