: ( ) ) ( ) ( ) ( ) SUPPLY TEACHING FORM > FORMULAIRE DE
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: ( ) ) ( ) ( ) ( ) SUPPLY TEACHING FORM > FORMULAIRE DE
Commission scolaire Western Québec Western Québec School Board 15, rue Katimavik, Gatineau QC J9J 0E9 Supply Teaching Form - Formulaire de suppléance Secondary - Secondaire/Adult Education - Éducation aux adultes Date: Select/sélectionnez Dec/déc Nov/nov Oct/oct Sept/sept Aug/août July/juil Jun/juin May/mai Apr/avril Mar/mars Feb/févr Jan/janv Given name(s)/prénom(s): Select Select/sélectionnez 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 123456789 2016 2020 2019 2018 2017 Family name/nom de famille: Address/adresse: Apartment/Unité #: City/ville: Postal Code: Province: Telephone/téléphone: Email/courriel: Teaching Diploma, Certificate (copies required) / Diplôme, certificat (copies requises): Brevet (Quebec Teaching Certificate) University/université OTC (Ontario Teachers College) Other: Please specify/autre: CEGEP/College None/aucun Secondary Schools where you would like to offer your supply teaching services/Écoles secondaires où vous aimeriez offrir vos services de suppléances: Gatineau: Hadley Junior/Philemon Wright High (Hull) Symmes Junior/D’Arcy McGee High (Aylmer) Maniwaki Woodland (Maniwaki) Namur Intermediate (Namur) Outaouais: St. Michael’s (Low) Dr. Wilbert Keon (Chapeau) Pontiac (Shawville) Pontiac: G. Theberge (Témiscaming) Golden Valley (Val d’Or) North/Nord: Noranda (Noranda) Adult Education Centres/Centres d’éducation aux adultes: (Specialty/spécialité) ( Hull Adult Education Centre (Hull -Gatineau) Golden Valley Cont. Education Centre (Val d’Or) ( Maniwaki Adult Education Centre (Maniwaki) ( Pontiac Adult Education Centre (Shawville) ( Western Québec Career Centre (Aylmer-Gatineau) ( Teaching subjects/matières d’enseignement:: History_English French SL Math_Science French Immersion Phys Ed Language of instruction / langue d’enseignement: English/anglais: French/français: Both/les deux Québec Qualified Office Use Only Qualified Outside Québec No Teaching Qualifications Verified by: ________________________ ) ) ) ) )