You may fill out our application below to submit to us, or you may download a copy of the application to print and mail it to us. Click here to download and print the application.

First Name:
Last Name:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
E-Mail:

Education Record

High School

Name:
Entered:
Completed:
Diploma/Degree:
Major Courses:

College/University

Name:
Entered:
Completed:
Diploma/Degree:
Major Courses:

Other

Name:
Entered:
Completed:
Diploma/Degree:
Major Courses:

*Transcript or diploma will be required at the time of hire.

Current Application:

Name of Current Employer:
Address of Current Employer:
Position Title:
Name of Supervisor:
Dates of Application From: To:
Salary (Start):
Finish:

List Two References:

Name:
Address:
Position:
Phone Number:
   
Name:
Address:
Position:
Phone Number:

At the time of hire, each of the above reference persons will need to submit a letter attesting to the applicant's suitability for working with children.

Experience with Children: (not including care of related children)

Site:
Supervisor:
Dates From: To:
Hours Per Week:
Describe Responsibilities:
Reason For Leaving:

 

Site:
Supervisor:
Dates From: To:
Hours Per Week:
Describe Responsibilities:
Reason For Leaving:

 

Site:
Supervisor:
Dates From: To:
Hours Per Week:
Describe Responsibilities:
Reason For Leaving:

*Upon hire, Act 33 clearance and a medical exam will be required.

NCCS is an equal Opportunity employer.

 

1356 N. Washington Ave.
Scranton, Pa 18509

570-341-0811
1-800-252-0811
Fax: 570-341-0817





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