Job Application - Luzerne County Head Start

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
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Email*
Position Desired*
Date Available to Start*
MM slash DD slash YYYY
You are available to work:*
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How many previous employers would you like to list?
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- Two
- Three
Previous Employer 1
Employer Name*
Employer Address*
Street Address Address Line 2 City State ZIP Code
Employer Phone
Position(s) Held
Length of Employment
Reason for Leaving
May we contact this employer for a reference?*
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- No
General Job Responsibilities*
Previous Employer 2
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Employer Phone
Position(s) Held
Length of Employment
May we contact this employer for a reference?
- Yes
- No
Responsibilities
Previous Employer 3
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Employer Phone:
Position(s) Held:
Length of Employment
May we contact this employer for a reference?*
- Yes
- No
Responsibilities
Please upload a resume and cover letter:
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How did you hear about us?*
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- Relative
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- 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 Profession
I 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
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Previous Employer 1

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