EMPLOYMENT APPLICATION
Thank you for your interest. So that we will have all the information needed to give your application the attention it
deserves, please be sure to read each section and complete it carefully. Do not reference resume. Incomplete
applications will NOT be considered. If you require accommodation due to a disability in order to complete the
application process, please let us know what accommodation you require.
PERSONAL AND BACKGROUND INFORMATION
Name (Last, First, MI) Telephone (day)
( )
Street Address Telephone (evening)
( )
City State Email:
Zip
Position(s) Applying for : Salary Desired: $_________
Schedule Desired: Full-Time Part-Time Summer Evening
Are you available to work evenings, weekends and/or holidays? Yes No
If yes, please specify:
Have you been employed by us before? Yes No
If so, when and in what position(s)?
Do you have any relatives working for our company? Yes No
If so, please list, with relationships.
Are you legally eligible to work in this country? Are you age 18 or older?
Yes No
If you are under 18, please indicate age and
Yes No date of birth:
If you are under 18, do you have working
papers?
Yes No
Have you ever been convicted of a crime? (Conviction is not necessarily a disqualification for
employment.)
Yes No
If you answered “yes,” please attach a separate page describing the nature of the offense(s), the
date(s) of the conviction(s) and the nature of any rehabilitation.
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EMPLOYMENT APPLICATION
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EMPLOYMENT APPLICATION
EDUCATION AND TRAINING
NO. OF DEGREE EARNED
LEVEL SCHOOL CITY STATE YEARS or NUMBER CREDITS GPA
High
School
Technical
College
College
Graduate
Graduate
Other
Please list all Specialized Certificates or Degrees you have earned.
Degree / Certificate Subject School City & State
If you are applying for a job which will entail transporting students and/or driving a College vehicle,
please answer the following:
Do you have a Driver’s License? Yes No
Do you have a Public Service License? Yes No
Do you have a Commercial Drivers Yes No
License?
Optional: Do you speak, read, or write a language other than English? Speak Read Write
Yes No
Language:
Language:
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EMPLOYMENT APPLICATION
EMPLOYMENT HISTORY
List all employment in order, beginning with current or most recent. Include military experience if
applicable. Do not reference resume. Attach additional pages if necessary
Employer Dates of Employment (month, year)
Salary / Wage
From: To: Start: End:
Mailing Address Position Type of Organization
City State Duties
Telephone Number
( )
Supervisor’s Name Reason for Leaving
May we contact for reference? Yes
Employer Dates of Employment (month, year)
Salary / Wage
From: To: Start: End:
Mailing Address Position Type of Organization
City State Duties
Telephone Number
( )
Supervisor’s Name Reason for Leaving
Employer Dates of Employment (month, year)
Salary / Wage
From: To: Start: End:
Mailing Address Position Type of Organization
City State Duties
Telephone Number
( )
Supervisor’s Name Reason for Leaving
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EMPLOYMENT APPLICATION
REFERENCES
Please list at least three employment references and two personal references (non-relatives) that you give
permission for us to contact.
Name Address Telephone Number How How Associated?
Long
Known?
( )
Employment:
( )
Employment:
( )
Employment:
( )
Personal:
( )
Personal:
( )
Personal:
We appreciate your willingness to voluntarily comply with our request to complete this
confidential survey. It will be kept separate from your employment application and will have
no bearing on hiring decisions.
Name (printed): Date:
Position Seeking:
HOW DID YOU LEARN ABOUT THE POSITION FOR WHICH YOU ARE APPLYING?
Location of Posting / Name of Referral Source
Posting
Newspaper Advertisement
Referral
Job Fair / Open House
Walk-in
Other: _______________________
