4101 MacCorkle Avenue, SE
Charleston, WV 25304
304-558-3570 or 800-654-4406
Consolidated Public Rerement Board
Section 1: To Be Completed By County Board of Education
Substitute Teacher Affidavit
I, ____________________________________, am the superintendent of schools for _________________________ County, West Virginia
and do hereupon my oath state as follows:
The above-listed County has a critical need of available substitute teachers, and the County Board of Education has concluded that
the use of retired teachers to serve in such positions is necessary to protect the education and welfare of its students.
The above-listed County has adopted a Critical Need Policy covering the employment of retired teachers as substitute employees
in order to address the problem of substitute teacher shortages as required by W. VA. Code § 18A-2-3.
The above-listed County's current critical need substitute teacher hiring policy is effective for the fiscal year listed above.
2020-2021 School Year
Date member notified County of his/her intent to retire _____________________ Date member retired ____________________
Date vacant position posted _____________________ Is the vacant position continually being posted? Yes No
As of the date of this form, list the number of days the retired teacher substituted in the current school year _________________
Date County Critical Need Policy was adopted ______________________
Date County Critical Need Policy was approved by the WV Department of Education _____________________
The following retired teacher has been rehired as a substitute teacher:
Name of Teacher ___________________________________________ Last 4 digits of SSN ___________________
Subject of substitute teaching _____________________________________________ Grade level taught ___________________
I hereby affirm that this affidavit is being submitted to the WV Department of Education for approval prior to a retiree
commencing work as a critical need substitute teacher.
I further affirm that no other substitute with the necessary certification and training in the subject matter being taught is available or
will accept said substitute position who is not retired under the Teachers' Retirement System pursuant to the provisions of W. VA.
Code §18-7A-1 et. seq.
Signature of Affiant/County Superintendent
AND FURTHER AFFIANT SAITH NOT.
Dated this ______________ day of ______________________, 20 ___________.
State of West Virginia,
County of ____________________________, to wit:
I, _____________________________________, a notary public in and for the county and state aforesaid, do hereby
certify and attest that __________________________________ did sign his/her name on the foregoing "Critical Need
Substitute Teacher Affidavit" before me on this the ______________ day of ______________________, 20_________.
My Commission Expires __________________________________________
Notary Signature ________________________________________________
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WVTF0015 February 18, 2021