DCTS - Support Staff Application

Personal Information

Please enter your personal information below.

First Name *

Last Name *

Email *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Phone *

Equal Rights Policy

Equal Right and Opportunities Policy

The 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 *

Position

Education

High School *

Attended *

Degree *

College

Attended

Degree

Graduate School

Attended

Degree

Other

Attended

Degree

Former Employment

List employment most recent first

Have you ever been employed by Dauphin County Technical School before?YesNo

Position Held

Employment Date

Employment End

Employer *

Employment Dates *

Street Address

City

State/Province

ZIP / Postal Code

Reference *

Phone *

Employer

Employment Dates

Street Address

City

State/Province

ZIP / Postal Code

Reference

Phone

Employer

Employment Dates

Street Address

City

State/Province

ZIP / Postal Code

Reference

Phone

Do we have permission to contact your present employer?YesNo

General Background Information

You 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? *YesNo

Are you currently under charges for a criminal offense? *YesNo

Have you ever forfeited bond or collateral in connection with a criminal offense? *YesNo

Within the last ten years, have you been fired from any job for any reason? *YesNo

Within the last ten years, have you quit a job after being notified that you would be fired? *YesNo

Have 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? *YesNo

ExplainationIf you answered "Yes" to any of the above questions, please provide a detailed explanation, including dates and your social security number.

References

Non-Related

First Name *

Last Name

Position *

Phone *

First Name

Last Name

Position

Phone

First Name

Last Name

Position

Phone

Do we have your permission to contact former employers and your personal references?YesNo

Document Uploads

PDE 6004 - Arrest or Conviction

Please complete the required PDE-6004 Form and upload the completed form below.

PDE 6004 - Arrest or Conviction *

No file chosen

Additional Documentation

Please upload anything else that you would like to be considered in your application (ie. Resume)

Additional Information

Additional 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 Employment

Copies 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.

Save as Draft