Lapeer County Intermediate School District
1996 West Oregon Street
Lapeer, Michigan 48446
Phone (810) 664-5917
FAX (810) 664-1011
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.
Lapeer County Intermediate School District
1996 West Oregon Street
Lapeer, Michigan 48446
Phone (810) 664-5917
FAX (810) 664-1011
Michigan Relay Voice/TTY 800-649-3777
Date: _______________________________
E-Mail Address:_____________________________
Last Name: ___________________________ First Name: _______________________ M.I.: _______
Position Applying For:
Gender:
Male
Sub Teacher
Female
Sub Paraprofessional
Sub Clerical
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?
Have you worked in a MI school (K-12) within one year (365 days) of today’s date?
Yes
Yes
No
No
Have you completed the G.C.N. Online Training Modules?
Yes
No
---------------------------------------------------------------------------------------------------------------------------Race (Please check all that apply):
White / Caucasian
Black / African American
American Indian or Alaska Native
Hispanic / Latino
Asian American
Native Hawaiian or Other Pacific Islander
--------------------------------------------------------------------------------------------------------------------------Name of EMERGENCY CONTACT:___________________________Relationship____________________
Phone Number______________________ Second Phone Number______________________________
--------------------------------------------------------------------------------------------------------------------------__________________________________
_____________________________________
Signature
Date
Lapeer County Intermediate School District
1996 West Oregon Street
Lapeer, Michigan 48446
Phone (810) 664-5917
FAX (810) 664-1011
Michigan Relay Voice/TTY 800-649-3777
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
District
Lapeer County Intermediate School District
1996 West Oregon Street
Lapeer, Michigan 48446
Phone (810) 664-5917
FAX (810) 664-1011
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
_______________________________________ School District.
F.B.I.
with
the
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 preemployment investigation, including the criminal records check, related to my
consideration for employment with any Michigan school district or non-public school.
____________________________________
_______________________
Employee Signature
Date
Lapeer County Intermediate School District
1996 West Oregon Street
Lapeer, Michigan 48446
Phone (810) 664-5917
FAX (810) 664-1011
Michigan Relay Voice/TTY 800-649-3777
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 Middle School (grades 5-8)
_____
_____
Dryden Community Schools (all grades)
Dryden Elementary (grades K-6)
_____
_____
_____
_____
_____
_____
_____
_____
_____
Almont High School (grades 9-12)
_____
Dryden Jr/Sr High School (grades 7-12)
Imlay City Community Schools (all grades)
Weston Street Elementary (grades K-2)
Imlay City Middle School (grades 6-8)
Imlay City High School (grades 9-12)
_____
_____
Borland Elementary School (grades 3-5)
Venture High School (alt ed, grades 9-12)
North Branch Area Schools (all grades)
North Branch Elementary School (grades K-4)
North Branch Middle School (grades 7-8)
Quest High School (alt ed, grades 9-12)
_____
_____
Ruth Fox Elementary School (grades 5-6)
North Branch High School (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)
Lynch Elementary (grades E5-5)
Mayfield Elementary (grades E5-5)
Turrill Elementary (grades E5-5)
Lapeer Community High( alt ed grades 9-12)
(Lapeer Community at Cramton)
_____ Murphy Elementary (grades K-5)
_____ Zemmer Middle School (6-8)
_____ Rolland Warner Middle School (6-8)
_____ Lapeer East High (grades 9-12)
_____ Lapeer West High (grades 9-12)
Days and Times you are available:
Before Noon:
_____ Monday/_____ Tuesday/_____ Wednesday/_____ Thursday/_____ Friday
After Noon:
_____ Monday/_____ Tuesday/_____ Wednesday/_____ Thursday/_____ Friday