Pediatric Therapeutic Services - www.pts-inc.net

Application - Making Your Next Career Move?

First Name:	Last Name:
Address 1:	Address 2:
City:	State:
Zip Code:	Phone:
Email:



Discipline: Speech Language Pathology Occupational Therapy Physical Therapy Psychology



Current Pennsylvania License: Yes No



Current Delaware License: Yes No



PA Dept of Education Certification: Yes No



Preferred Student Population: (check any that apply): School Age Early intervention MR Autistic Severely/profoundly impaired students Mildly involved students only Mild to moderately involved students Blind Deaf



I am interested in work in the following counties: Chester County, PA Delaware County, PA Bucks County, PA Montgomery County, PA Lancaster County, PA Berks County, PA



I am interested in: full-time part-time work