Employment Application

Position Applying For*
First Name*
Last Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone
EMPLOYMENT HISTORY
Employer 1
Employer Name Position Held Supervisor Name Dates of Employment (from/to) Reason for Leaving
Employer 2
Employer Name Position Held Supervisor Name Dates of Employment (from/to) Reason for Leaving
Employer 3
Employer Name Position Held Supervisor Name Dates of Employment (from/to) Reason for Leaving
EDUCATION
Highest level (or grade) of education completed?
High School
Name of School Years Completed Diploma (yes or no)
College/Other
Name of School Years Completed Degree or Major
College/Other
Name of School Years Completed Degree or Major
Information needed for employment consideration:
Do you have a vehicle to use on the job?
- Yes
- No
Do you have a child in one of our programs?
- Yes
- No
If yes, which program?
Have you ever worked for our agency before?
- Yes
- No
If yes, what position and when?
Professional References
Please provide information of three individuals that are familiar with your character, ability, or education. Do not include friends or relatives.
Reference 1
First Name Last Name Telephone Email Relationship to Applicant
Reference 2
First Name Last Name Telephone Email Relationship to Applicant
Reference 3
First Name Last Name Telephone Email Relationship to Applicant
May we contact your current employer?
- Yes
- No
List any other experience not previously listed, such as volunteer work or courses taken, that is relevant to the position for which you are applying.
Why are you interested in working for SUMMIT Early Learning?
Resume and Cover Letter
Drop files here or
Please upload Resume and Cover letter here.
Condition of employment application:*
I have read and understand the below statements,
I UNDERSTAND THAT:
1. Any false or incomplete information in my application may be reason for denying employment, or if employed, termination from employment.
2. SUMMIT Early Learning, Inc. may contact my former employers and professional references to determine any acceptability for employment. I release anyone who provides information and SUMMIT Early Learning from any and all liability and responsibility by reason of their so doing.
3. If I am selected for a position, I am aware that by law I must apply for and receive a clearance check from the Pennsylvania State Police, FBI, and from the Pennsylvania Department of Human Services, the child abuse state registry. Application must be made at time of acceptance of job offer.
4. All new employees beginning employment 1/1/86 or later must abide by PA ACT 33, amended by ACT 80, and any future amendments.
5. I further understand that this is an application for employment and that no employment contract is being offered.
Applicant Certification*
I understand the below statement.
IF HIRED, MY EMPLOYMENT MAY BE TERMINATED IF I HAVE BEEN NAMED AS THE PERPETRATOR OF A FOUNDED REPORT OF CHILD ABUSE LONGER THAN 5 YEARS AGO OR THE PERPETRATOR OF AN INDICATED REPORT OF CHILD ABUSE.
Name
This field is for validation purposes and should be left unchanged.

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SUMMIT Early Learning, Inc.
14 South 11th Street
Mifflinburg, PA 17844
(570) 966-2845

Employer Name	Position Held	Supervisor Name	Dates of Employment (from/to)	Reason for Leaving

Employer Name	Position Held	Supervisor Name	Dates of Employment (from/to)	Reason for Leaving

Employer Name	Position Held	Supervisor Name	Dates of Employment (from/to)	Reason for Leaving

Name of School	Years Completed	Diploma (yes or no)

Employment Application

EMPLOYMENT HISTORY

EDUCATION

Information needed for employment consideration:

Professional References

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