SAPP Provider Enrollment Form
The following information is needed for the creation of your ConnectTeam profile, time clock and job scheduler.
Enrollment Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
*
First Name
Last Name
Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Location Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
If an aide has to reach out to someone at the location, who is the best contact? Please provide their name and number.
Email
*
example@example.com
Position at your location
*
County your facility is located in?
*
Please Select
Lycoming
Clinton
Tioga
Location Name
*
Location Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Hours of operation for your location
*
Please describe your typical shift structure below. This will allow for pre made templates to be created in your job scheduler- making it easier for you to post shifts! (Example: My facility works on 8 hour and 4 hour shifts- 6:00am-3:00pm/6:00am-10:00am/2:00pm-6:00pm)
Do you allow breaks during your shifts?
*
Yes
No
If you answered YES above, please describe your break structure below.
Do you have a dress code for classroom aides? If yes, I will collect that from you as part of your profile.
Yes
No
Document Upload: If you have any employee manuals, specific policies, or any other important documents that a substitute aide should review PRIOR to working a shift in your facility, please upload them here. These documents can be attached to your ConnectTeam profile for aides to access.
Browse Files
Drag and drop files here
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Would you be interested in providing a customized welcome video for your ConnectTeam profile? This could be a GREAT way for substitute aides to learn a little about you and your facility before working their first shift with you!
*
Yes
No
Will you be the ConnectTeam administrator for your location?
*
Yes
No
Please list any additional location/address that a Substitute Aide may need to be at as part of working a shift in your facility.
If you answered NO above- provide Full Name of ConnectTeam Administrator
First Name
Last Name
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