EMPLOYMENT APPLICATION Position Applying For*Please chooseAny Position/OtherAssistant Teacher (Centers for School Age Development, Selinsgrove)Assistant Teacher (Centers for School Age Development, Lewistown)Assistant Teacher (Susquehanna)Disabilities/Mental Health Specialist (Mifflin County)Education Services CoordinatorSubstitute Teacher, as needed (Snyder County)Teacher - Early Head Start (Lewisburg)Teacher - Head Start (Lewistown)Teacher - Head Start/Childcare (Lewistown)Teacher - Head Start/Childcare (Mifflinburg)Teacher - Toddlers (Lewistown)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 HISTORYEmployer #1Employer Name & AddressPositionDates of EmploymentReason for Leaving Employer #2Employer Name & AddressPositionDates of EmploymentReason for Leaving Employer #3Employer Name & AddressPositionDates of EmploymentReason for Leaving EDUCATIONHighest Level of Education (or Grade) Completed ListSchool (high school, college, other)Degree or grade completedCourse of Study (major, degree) INFORMATION NEEDED FOR EMPLOYMENT CONSIDERATIONDo 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 REFERENCESPlease 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 ADDRESSOCCUPATIONPROFESSIONAL RELATIONSHIP TO APPLICANT Professional Reference #2:NAME, ADDRESS, PHONE NUMBER, EMAIL ADDRESSOCCUPATIONPROFESSIONAL RELATIONSHIP TO APPLICANT Professional Reference #3:NAME, ADDRESS, PHONE NUMBER, EMAIL ADDRESSOCCUPATIONPROFESSIONAL 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. Δ SUMMIT Early Learning requires current and valid Background Clearances.