Employment Application

• Position Applying For*Please chooseAny Position/OtherAssistant Teacher – Head Start / Child Care (Lewistown)Assistant Teacher – Head Start / Child Care (Selinsgrove)Assistant Teacher – Traveling (Middleburg Area)Assistant Teacher – school-age program (various locations)Center Director (Lewistown)Early Head Start Home Visitor (Mifflinburg)Mental Health Specialist (Mifflin County)Mental Health Specialist (Snyder County)Teacher – Head Start / Child Care (Lewistown)Teacher – Head Start (Lewistown)Teacher – Head Start (West Snyder)Teacher – school-age program (various locations)
• First Name*
• Last Name*
• Date MM slash DD slash YYYY
• Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Email*
• Phone*
• Preferred Contact Method, please select all that apply.
  • Email
  • Text
  • Phone

• EMPLOYMENT HISTORY

• Employer #1

  Employer Name & Address	Dates of Employment	Reason for Leaving

• Employer #2

  Employer Name & Address	Dates of Employment	Reason for Leaving

• Employer #3

  Employer Name & Address	Dates of Employment	Reason for Leaving

• EDUCATION

• Highest Level of Education (or Grade) Completed
• List

  School (high school, college, other)	Degree or grade completed	Course of Study (major, degree)

• INFORMATION NEEDED FOR EMPLOYMENT CONSIDERATION

• Do you have a vehicle to use on the job?
• If you have a child enrolled in one of our programs, select the program below.
  • Head Start or Early Head Start
  • Pre-K Counts
  • Child Care
  • Center for School-age Development
  • Summer Camp
• Have you ever worked for SUMMIT Early Learning before?
  • Yes
  • No
• If yes, what position and when?

• PROFESSIONAL REFERENCES

  Please list the names of three persons familiar with your character, ability, or education for more than one year. Do not include friends or relatives.
• Professional Reference #1:

  NAME, ADDRESS, PHONE NUMBER, EMAIL ADDRESS	OCCUPATION	PROFESSIONAL RELATIONSHIP TO APPLICANT

• Professional Reference #2:

  NAME, ADDRESS, PHONE NUMBER, EMAIL ADDRESS	OCCUPATION	PROFESSIONAL RELATIONSHIP TO APPLICANT

• Professional Reference #3:

  NAME, ADDRESS, PHONE NUMBER, EMAIL ADDRESS	OCCUPATION	PROFESSIONAL RELATIONSHIP TO APPLICANT

• Please specify any restrictions regarding contacting your current employer:
• List any other experiences not previously listed, such as volunteer work, that are relevant to the position for which you are applying:
• Why are you interested in working for SUMMIT Early Learning?
• How did you hear about this position?
  • SUMMIT Employee
  • Friend / Family
  • Facebook
  • Indeed
  • LinkedIn
  • Website
  • Hiring Sign
  • Other
• If you were referred by a current SUMMIT employee, please enter their name here.
• Resume & Cover Letter (if applicable) Drop files here or Select files Max. file size: 300 MB.
  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.
• PhoneThis field is for validation purposes and should be left unchanged.

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