Speech-Language Pathologists (Pediatrics)

Job Code: 1568771 Location: Manhattan

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* FIRST NAME	M.I.	* LAST NAME

* HOME PHONE (xxx)xxx-xxxx	WORK PHONE (xxx)xxx-xxxx

* EMAIL

* ADDRESS

* CITY	* STATE/PROVINCE	* POSTAL CODE

* COUNTRY

1. HAVE YOU EVER BEEN AN EMPLOYEE OF YAI/NIPD BEFORE? *

Yes
No

2. IF YES, PLEASE INDICATE WHEN, THE NAME OF THE PROGRAM AND THE NAME OF YOUR SUPERVISOR.

3. ARE YOU LEGALLY EMPLOYABLE UNDER U.S. IMMIGRATION LAWS? (PROOF OF CITIZENSHIP OR IMMIGRATION STATUS WILL BE REQUIRED UPON EMPLOYMENT). *

Yes
No

4. IF NO, PLEASE INDICATE IMMIGRATION STATUS

5. ARE YOU NYS LICENSED AS A SPEECH LANGUAGE PATHOLOGIST? *

Yes
No

6. IF NO, PLEASE INDICATE IF YOUR ARE LOOKING FOR A CFY OR WHEN YOU WILL OBTAIN YOUR LICENSE.

7. DO YOU HOLD A CCC? *

Yes
No

8. ARE YOU NYS CERTIFIED AS A TEACHER OF THE SPEECH AND HEARING HANDICAPPED (TSHH) OR IN TEACHING STUDENTS WITH SPEECH-LANGUAGE DISORDERS (TSSLD)? *

Yes
No

9. DO YOU HAVE EXPERIENCE EVALUATING AND TREATING CHILDREN AGES BIRTH TO FIVE WITH SPECIAL NEEDS? *

Yes
No

10. WHICH LOCATIONS ARE YOU INTERESTED IN? PLEASE SPECIFY IN ORDER OF PREFERENCE *

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11. PLEASE INDICATE YOUR DESIRED POSITION. *

Homebased Fee-For-Service
Full-Time Centerbased Preschool
Part-time Centerbased Preschool

12. PLEASE SPECIFY YOUR MINIMUM SALARY REQUIREMENT. *

* PLEASE PASTE A COPY OF YOUR RESUME OR PROFILE BELOW.