Job Application Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhoneCell PhoneEmail* Position Desired* Date Available to Start* MM slash DD slash YYYY You are available to work:*Check all that apply. Select All Full Time Substitute Part Time Temporary How many previous employers would you like to list? One Two Three Previous Employer 1Employer Name* Employer Address* Street Address Address Line 2 City State 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 ZIP Code Employer PhonePosition(s) Held Length of Employment Reason for Leaving May we contact this employer for a reference?* Yes No General Job Responsibilities*Previous Employer 2Employer Name Employer Address Street Address Address Line 2 City State 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 ZIP Code Employer PhonePosition(s) Held Length of Employment May we contact this employer for a reference? Yes No ResponsibilitiesPrevious Employer 3Employer Name Employer Address Street Address Address Line 2 City State 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 ZIP Code Employer Phone:Position(s) Held: Length of Employment May we contact this employer for a reference?* Yes No ResponsibilitiesPlease upload a resume and cover letter: Drop files here or Select files Max. file size: 5 MB. EducationHigh SchoolName and Address of High School* Course of Study Years attendedDegree Attained* Undergraduate/Graduate UniversityName and Address of College/University Course of Study Years attendedDegree Attained Graduate/Professional DegreeName and Address of College/University Course of Study Years attendedDegree Attained Other EducationPlease list any additional Educational or Specialized Training you have received related to the job for which you are applying:*You must provide a copy of the Diploma/Certificate from your highest level of education achieved. Please also provide official copies of your undergraduate and/or graduate transcripts if applicable. NOTE: Applicants must be eighteen (18) years of age or older; High School Diploma or G.E.D. is a requirement for all positions. Please list here any volunteer hours you may have donated at a Head Start center, list location and a brief description of the duties you performed:Have you ever filed an application with us before?* Yes No If yes, give date: MM slash DD slash YYYY Have you ever worked for us before?* Yes No If yes, give date: MM slash DD slash YYYY Are you a US citizen or have appropriate documentation to show you are eligible to work in the US?*Proof of citizenship or immigration status will be required upon employment. Yes No Our typical hours of operation are between the hours of 7:00 am and 4:30 pm; Please indicate the hours you are available to work:* Are you now or have you been a parent/grandparent of a child enrolled in Head Start?* Yes No If yes, what year? Indicate any languages you can speak, read or write:*Can you travel if a job requires it?* Yes No How did you hear about us?* Advertisement Relative Friend Employment Agency Other If other, please indicate:If other, please indicate: Please answer the following questions briefly, but in the space allowed. You may be asked to expand upon your answers in an interview format. 1. Why have you chosen to work in Early Childhood Education and/or for the position for which you have applied?*2. What do you find rewarding about working with children and families?*3. Please complete this question if the position you are applying for directly provides services to children and families: When you walk past a classroom you notice a respected veteran teacher handling a child roughly, pulling the child’s arm and sitting the child harshly into a seat, and speaking with an inappropriate tone and attitude. You are the only witness to this incident, what would you do?4. Please complete this question if the position you are applying for directly provides services to children and families: A child in your classroom has been bitten. The mother of the child is furious and demands to know who bit her child and even goes as far as to threaten legal action if the identity of the child who bit her child is not disclosed immediately. How would you handle this parent?Please List 3 References*Include Name, Phone Number, Relationship to You, and ProfessionI certify that the answers and information given herein are true, correct and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the event of employment, I understand that false of misleading information given in my application or interview(s) may result in termination regardless of when the information is discovered to be false or misleading. I understand that the Pennsylvania State Police Criminal Record Check, Pennsylvania Child Abuse History Clearance and FBI Fingerprints Clearance (Via registration through the DHS) are required Conditions of Employment.* I agree I disagree WE ARE AN EQUAL OPPORTUNITY EMPLOYER CAPTCHAEmailThis field is for validation purposes and should be left unchanged.