Support Staff ApplicationPersonal InformationPlease enter your personal information below.First Name *Last Name *Email *Street Address *City *State/Province *ZIP / Postal Code *Phone *Equal Rights PolicyEqual Right and Opportunities PolicyThe Dauphin County Technical School is an equal opportunity education institution and will not discriminate on the basis of race, color, national origin, sex, or handicap in its activities, programs, or employment practices as required by Title VI, Title IX, and Section 504. For information regarding civil rights or grievance procedures, contact our Title IX Coordinator or Section 504 Coordinator at 6001 Locust Lane, Harrisburg, PA 17109 (717) 652-3170. For information regarding services, activities, and facilities that are accessible to and usable by handicapped individuals and groups, please contact the Administrative Director.Position Desired *Select OneMaintenanceCafeteriaCustodianParaeducatorOtherPositionEducationHigh School *Attended *Degree *CollegeAttendedDegreeGraduate SchoolAttendedDegreeOtherAttendedDegreeFormer EmploymentList employment most recent firstHave you ever been employed by Dauphin County Technical School before?YesNoPosition HeldEmployment DateEmployment EndEmployer *Employment Dates *Street AddressCityState/ProvinceZIP / Postal CodeReference *Phone *EmployerEmployment DatesStreet AddressCityState/ProvinceZIP / Postal CodeReferencePhoneEmployerEmployment DatesStreet AddressCityState/ProvinceZIP / Postal CodeReferencePhoneDo we have permission to contact your present employer?YesNoGeneral Background InformationYou must give complete answers to all questions. If you answer "Yes" to any question, you must list all offenses, and for each conviction provide date of conviction and disposition, regardless of the date or location of occurrence. Conviction of a criminal offense is not a bar to employment in all cases. Each case is considered on its merits. Your answers will be verified with appropriate police records.Criminal Offense includes felonies, misdemeanors, summary offenses and convictions resulting from a plea of "nolo contendere" (no contest).Conviction is an adjudication of guilt and includes determinations before a court, a district justice or a magistrate, which results in a fine, sentence or probation.You may omit: minor traffic violations, offenses committed before your 18th birthday which were adjudicated in juvenile court or under a Youth Offender Law, and any convictions which have been expunged by a court or for which you successfully completed an Accelerated Rehabilitative Disposition program.Were you ever convicted of a criminal offense? *YesNoAre you currently under charges for a criminal offense? *YesNoHave you ever forfeited bond or collateral in connection with a criminal offense? *YesNoWithin the last ten years, have you been fired from any job for any reason? *YesNoWithin the last ten years, have you quit a job after being notified that you would be fired? *YesNoHave you ever been professionally disciplined in any state? *YesNoProfessional disciplined means the annulment, revocation or suspension of your teaching certification or having received a letter of reprimand from an agency, board or commission of state government, such as the Pennsylvania Professional Standards and Practices Commission.Are you subject to any visa or immigration status, which would prevent lawful employment? *YesNoExplainationIf you answered "Yes" to any of the above questions, please provide a detailed explanation, including dates and your social security number.ReferencesNon-RelatedFirst Name *Last NamePosition *Phone *First NameLast NamePositionPhoneFirst NameLast NamePositionPhoneDo we have your permission to contact former employers and your personal references?YesNoDocument UploadsPDE 6004 - Arrest or ConvictionPlease complete the required PDE-6004 Form and upload the completed form below.PDE 6004 - Arrest or Conviction *Choose FileNo file chosenDelete uploaded fileAdditional DocumentationDrag and Drop (or) Choose FilesPlease upload anything else that you would like to be considered in your application (ie. Resume)Additional InformationAdditional InformationProvide any additional information you may wish to submit that will support your application. Please indicate why you are interested in being employed by the Dauphin County Technical School.CertificationYesNoI certify that the preceding information is true and complete. I further understand that, once submitted, this application becomes the property of the Dauphin County Technical School. Information submitted on or as part of this statement shall be accorded confidentiality as required by the applicable regulations of the Pennsylvania Department of Education.SignatureBy typing your full name you consent to the use of digital signature.Required forms for EmploymentCopies of Act 34 Security Clearance, Act 114 FBI Fingerprint Clearance, and Act 151 Child Abuse Clearance are required of each employee before employment can commence.ACT 34 (Background Check of Prospective Employees)Each Pennsylvania resident must submit with his/her employment application a copy of a report of Criminal History Record Information from the Pennsylvania State Police or a statement from the Pennsylvania State Police that the State Police Central Repository contains no such information relating to that person. Each out-of-state applicant must submit with his/her application for employment a copy of a federal criminal record history from the Federal Bureau of Investigation. The criminal record history report must be no more than one (1) year old. The applicant MUST submit the ORIGINAL report prior to employment.ACT 114 (FBI Federal Criminal History Records for Prospective Employees)Each candidate must submit with his/her employment application a copy of his/her Federal Criminal History Record. The clearance statement must be no more than one (1) year old. The applicant MUST submit the ORIGINAL report prior to employment.ACT 151 (PA Child Abuse History Clearance)Each candidate must submit with his/her employment application a copy of an official clearance statement obtained from the Pennsylvania Department of Public Welfare or a statement from the Department of Public Welfare that no record exists. The clearance statement must be no more than one (1) year old. The applicant MUST submit the ORIGINAL report prior to employment.SubmitSave as Draft