PRESENT ASSIGNMENT:



EASTERN SUFFOLK BOCES

EDUCATIONAL SERVICES DIVISION

2014 SPECIAL EDUCATION - SUMMER SERVICES APPLICATION

NON-BOCES CANDIDATES

CHECK POSITION(S) DESIRED:

TEACHER (MUST BE SPECIAL ED CERTIFIED):

LIST AREAS OF CERTIFICATION: ___________________________________________________

TEACHING ASST. (min. 60 college credits): _____ SOCIAL WORKER:

TEACHER AIDE (min. HS diploma): SPEECH:

NURSE: PSYCHOLOGIST:

SPECIAL SUBJECT(please specify): ______ ____________OTHER (please specify): _________________

LIST AREAS OF CERTIFICATION IF APPLICABLE:_________________

PLEASE PRINT CLEARLY

NAME:

Please provide ALL names that you have previously used for employment (ex; maiden name, shortened 1st name, married name, etc.)

ADDRESS:

CITY (include zip code)

PHONE: (include area code

EMAIL ADDRESS:

Your email address will be used to send a confirmation receipt for your application. Please do not respond or send any

additional email inquiries.

If referred by an Eastern Suffolk BOCES employee, please complete information below:

EMPLOYEE NAME:_______________________LOCATION:________________RELATIONSHIP___________________

_________________________________________________________________________________

PLEASE SELECT FROM THE FOLLOWING :

EVERY EFFORT WILL BE MADE TO OFFER YOU YOUR CHOICE, BUT THERE CAN BE NO GUARANTEES

|PROGRAM 1ST CHOICE |HALF DAY OR FULL DAY |PROGRAM 2ND CHOICE |HALF DAY OR FULL DAY |

| | | | |

PLEASE SUBMIT APPLICATION NO LATER THAN APRIL 21, 2014 USING ONE OF

THE FOLLOWING METHODS: ****EMAIL SUBMISSIONS PREFERRED****

• Email: summerservices@

• Mail To: Eastern Suffolk BOCES, Liz Melichar, 15 Andrea Rd., Holbrook, NY 11741

• Inter-Office Envelope: Dept. of Special Education/Sherwood-ATTN: Liz Melichar

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