Southeastern Community College

Human Resources Office

4564 Chadbourn Highway, P.O. Box 151
Whiteville, NC 28472-0151
Phone (910) 642-7141, ext. 310 Fax (910) 642-5658
Please read and follow all instructions before completing the Application for Employment. Please retain this page for your
information and return all other pages to Southeastern Community College as part of your application packet.

APPLICATION FOR EMPLOYMENT PROCEDURES

Thank you for choosing Southeastern Community College (SCC) as a potential place of employment. It is our goal to
provide quality educational programs and services for our students, faculty, staff, and community. In order to fulfill our
mission, we endeavor to employ the most qualified personnel available without regard to age, race, sex, color, religion,
national origin, disability, or political affiliation.
Currently advertised position announcements are available by selecting the Employment Opportunities link. Click on
the position title to learn more about the vacancy. Please read position vacancy announcements very carefully as specific
requirements such as position qualifications, job duties, deadline dates, and application requirements may vary. In order
to be considered for employment, you must print the Application for Employment and Release Authorization forms,
complete the Application for Employment according to instructions located at the top of the form, and complete
and sign the Release Authorization form. Return all pages of the forms via US mail or fax them along with a copy of
your resume and post secondary educational transcripts to the Human Resources Office by 5:00 p.m. on or before the
deadline date. If submitting by fax, original signed application forms and accompanying materials must be mailed
immediately to the address above. Applications received after the deadline date will be considered if a second review
becomes necessary. Photocopies of educational transcripts are allowed for the screening process. However, official
educational transcripts are required prior to employment. Failure to submit complete and signed required application
materials and forms may delay the processing of your application or result in non-consideration. All applications
will be acknowledged in writing when received by the Human Resources Office.
Completion of the Equal Opportunity Information section of the employment application (Page 3 of 4) is for our records
only. Because SCC prohibits discrimination in its staffing process, responses received in section A related to age, gender,
and ethnicity will not be used in the selection process but are a valuable tool in determining how well our recruitment
efforts are reaching all segments of the population and which media of advertisement is most effective and cost efficient.
Applications for Employment received when no position vacancies exist are placed in active status for six months, with
the exception of clerical and custodial/maintenance positions, which are accepted only when a vacancy exists. If parttime employment is desired and indicated with a check on the application form, a copy of the application materials is sent
to the appropriate supervisor(s) for review for current or future vacancies. During the six-month active status, applicants
may request to have their application reactivated when a position has been advertised for which the applicant has applied
or is qualified. At the end of the six-month period, applications are placed in an inactive status and the applicant will be
required to resubmit and updated application for future consideration. Subsequent reactivations are to be requested in like
manner.
Please feel free to contact the Human Resources Office at (910) 642-7141, ext. 310, should you have any
questions regarding the staffing process.

FOR HUMAN RESOURCES OFFICE USE ONLY

Name:____________________________________

Application For Employment

Southeastern Community College
Human Resources Office
P. O. Box 151, Whiteville, North Carolina 28472
PLEASE READ THESE INSTRUCTIONS CAREFULLY BEFORE YOU COMPLETE THIS APPLICATION
(TYPE OR PRINT IN BLACK INK ONLY)
AVAILABILITY:

Your application will be kept active for six months and you will be notified of any vacancies in positions for which you have applied
or may be qualified. (Applications for clerical or maintenance positions are accepted only when there is a specific vacancy.) At the
end of six months we will deactivate your application unless we receive a request from you that your application be continued in an
active status.

WORK HISTORY: Begin with your most recent job, including all paid employment as well as all military or volunteer work, which you feel might help
you in the job(s) for which you are applying. If you had different jobs for the same employer, describe each job separately. Describe
in DETAIL what you did at each job starting with your main duties. If you were a supervisor, describe the type of employees you
supervised. The work history is used to evaluate qualifications and calculate salaries. It is vital that a complete work history
be provided. A resume cannot be submitted in lieu of the work history, but is required for application.
SIGNATURE OF APPLICANT: You must sign and date this application. An unsigned application will not be processed.
REFERENCES:

Last Name

If you wish to give references in addition to supervisors listed in the WORK HISTORY section, attach another sheet giving names,
addresses, and telephone numbers.
First Name

Middle Name

Mailing Address (P. O. Box Number or Street Number and Name)

Home Phone
(Hrs. when can be reached)

Are you a veteran?

YES

Business Phone
(Hrs. when can be reached)

City

State

Zip Code

Permanent address if different from above:

NO Date of entry into military service _________________________

Separation date

Social Security Number

Are you related by blood or marriage to any person

working for the college?

Type of separation ____________________________

___Yes

___No

Enter below the specific title(s) of the job(s) for which you are applying.
This Section Must Be Completed For Your Application To Be Evaluated.
1.

3.

2.

4.

Check the type of work you will accept:

Regular full-time

Regular part-time

Temporary full-time

Temporary part-time

Work involving travel

Irregular hours

If you are not available for work now, enter the earliest date you could begin work (mo./day/yr.)
LIST fields or tasks for which you are licensed, registered, or certified giving date(s) and source(s) of issuance.
EDUCATION
Circle highest grade completed
SCHOOLS

1 2 3 4 5 6 7 8 9 10 11 12
Name & Location

GED

College 1 2 3 4 Graduate School 1 2 3 4

No. of Hrs. (Designate Sem. or Qtr.)

Major/Minor

Degree & Date

HIGH SCHOOL

COLLEGE/UNIVERSITY
GRADUATE

Affirmative Action/Equal Opportunity Employer

P AGE 1 OF 4

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WORK HISTORY

(This page may be photocopied as needed to provide a complete work history)

A resume cannot be substituted in lieu of the work history.

Current or Last Employer:

Address:

May We Contact Employer?

YES

Job Title:

Supervisor:

Date Employed (mo./yr.)

Starting Salary
$

Date Separated (mo./yr.)

per

Ending Salary
$

Phone No.

NO

No. Supervised by You:

Reason for Leaving

per

Duties:

Full Time

Years

Months

Part Time

Years

Months

If part time, number of

hours worked per week
Current or Last Employer:

Address:

May We Contact Employer?

YES

Job Title:

Supervisor:

Date Employed (mo./yr.)

Starting Salary
$

Date Separated (mo./yr.)

per

Ending Salary
$

Phone No.

NO

No. Supervised by You:

Reason for Leaving

per

Duties:

Full Time

Years

Months

Part Time

Years

Months

If part time, number of

hours worked per week
Current or Last Employer:

Address:

May We Contact Employer?

YES

Job Title:

Supervisor:

Date Employed (mo./yr.)

Starting Salary
$

Date Separated (mo./yr.)

per

Ending Salary
$

Phone No.

NO

No. Supervised by You:

Reason for Leaving

per

Duties:

Full Time

Years

Months

Part Time

Years

Months

If part time, number of

hours worked per week

Affirmative Action/Equal Opportunity Employer

PAGE 2 OF 4

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EQUAL OPPORTUNITY INFORMATION

Southeastern Community College policy prohibits discrimination based on age, race, sex, color, religion, national origin, disability
or political affiliation. The information requested below will not be used in the selection process. Its sole use will be to see how well
our recruitment efforts are reaching all segments of the population.
_______________________________________________________________________________________________________________
Section A

NAME: _________________________________________________________________________
POSITION(S) FOR WHICH APPLIED:
1.

3.

2.

4.

WHERE DID YOU LEARN ABOUT THE POSITION OPENING(S)?

Newspaper _______________________________________ Internet Site: ________________________________

SCC Website
Friend/Relative
SCC Bulletin Board
Other: _______________________________________

DATE OF BIRTH

SEX PLEASE CHECK ONE

_____
(Mo)

_______ _______
(Male)
(Female)

_____
(Day)

_____
(Year)

ETHNIC GROUP
1.
2.
3.
4.
5.

White Non-Hispanic
Black Non-Hispanic
American Indian or Alaskan Native
Hispanic (Mexican, Puerto Rican, Cuban, Central or South America, other Spanish origin regardless of race)
Asian or Pacific Islands

Section B

Can you perform the essential functions of the job(s) for which you are applying?

YES

NO

YES

NO

YES

NO

*Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?

__ YES

NO

*Have you ever been convicted of a charge other than a misdemeanor or plead no contest to such a charge?
(A conviction does not mean you cannot be hired. The offense and how recently you were convicted will be
evaluated in relation to the job(s) for which you are applying.)

___YES

NO

*If no, can your perform the essential functions of the job with a reasonable accommodation?

*Have you ever been dismissed, suspended, or asked to resign from a position?

*(If you responded yes to one or more of these questions, explain fully on additional sheet for each yes response.)

Affirmative Action/Equal Opportunity Employer

PAGE 3 OF 4

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Southeastern Community College

Release Authorization
Southeastern Community College is an affirmative action, equal opportunity employer providing
equal employment and advancement to qualified persons without regard to age, race, sex, color, religion,
national origin, disability or political affiliation.
I, the undersigned, in consideration of my application for employment do hereby authorize
Southeastern Community College (SCC) to conduct, at its discretion, an investigation into my personal
and employment history which may include but not be limited to criminal history, motor vehicle driving
record, educational verification, employment history, and credit report.
I hereby authorize employers, agencies, personal references and other persons with whom I am
acquainted to answer all questions and release all information concerning my employment record,
character, reputation, ability, education, military service, credit history, and other applicable records.
Furthermore, I release, indemnify, and forever hold harmless SCC or their agents and former
employers, their agents, or assigns, from any and all claims and/or liabilities that may arise as a result of
these investigations, and from any claim or liability which results from any physical examination, drug
testing procedure, x-rays, or other medical diagnostic procedures conducted by them or their suppliers.
Further, I release, indemnify, and forever hold harmless any person, corporation, company, institution, or
individual and their agents and assigns who may act upon the authority of this release.
I certify that all of the statements made in this application and any attached documents are true,
complete, and correct to the best of my knowledge and belief and are made in good faith. I understand
that false information, omissions, or misrepresentation given in my application, attachments, or
interview(s) may be grounds for rejection of my application and/or immediate dismissal if I am
employed. I understand that the information requested below regarding sex, race and date-of-birth is for
the sole purpose of gathering the above background information accurately and will not be used to
discriminate against me in violation of the law. A facsimile (FAX) or photocopy of this authorization
shall be as valid as the original.

Applicants Full Name

Social Security Number

(Unsigned applications will not be processed.)

Maiden or Other Name Used

Drivers License Number/State Issued

Address

Date of Birth

City/State/Zip Code

Applicants Signature

Affirmative Action/Equal Opportunity Employer

PAGE 4 OF 4

Sex

Race

Date
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