APPLICATION FOR EMPLOYMENT

Transcription

1 APPLICATION FOR EMPLOYMENT NAME: Date of Application: Illinois Valley Community College is an Equal Opportunity, Affirmative Action Employer. Applications are considered for employment, and employees are treated without regard to age, religion, national origin, color, sex, or mental or physical handicap, except where such conditions are bona fide occupational requirements. The Illinois Valley Community College campus is accessible to disabled applicants. This application is only for a specific position and will be kept in an inactive file for one (1) year. The applicant must contact the Human Resources Office to reactivate the filed application for another position opening. All positions are contingent upon the approval of the President and the Board of Trustees. ADDRESS: CITY, STATE, & ZIP: (PLEASE PRINT OR TYPE) (Last) (First) (Middle) (Street) TELEPHONE NUMBER: (Day Telephone No.) (Evening Telephone No.) Specific position for which you are applying: Date available for employment: Are you legally authorized to work in the U.S.? Are you related to any employee at Illinois Valley Community College or a member of the same household? If so, please indicate his/her name and your relationship: Were you previously employed by us? Yes No If yes, when and what position? Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, in the past seven years which has not been annulled or expunged or sealed by a court? Yes No If yes, please explain: (NOTE: You are not required to disclose a conviction if the records have been sealed or expunged. A conviction record will not necessarily bar employment.) Rev. 04/10 Page 1

2 EDUCATION HIGH SCHOOL ATTENDED Name and Location of School Total Year Completed (Check One) Diploma Earned? (Please Check an Answer) Yes No If you did not receive a high school diploma, do you have a GED diploma? (Please check one) Yes No TRADE, TECHNICAL, BUSINESS, OR MILITARY SCHOOL(S) ATTENDED Name of School City, State Name of School City, State Degree Earned Degree Earned COLLEGES OR UNIVERSITIES ATTENDED Name of School City, State Field/Study Degree Earned NIGHT SCHOOLS OR SHORT COURSES ATTENDED School or Sponsoring Organization City, State Certificate Field of Study Do you hold any special licenses or certifications: (Please check an answer) Yes No If so, please list: List any scholarships and /or professional honors received: Rev. 04/10 Page 2

3 PREVIOUS EXPERIENCE The information contained on this application may be used to evaluate and score your training and experience for particular classification. Please be specific and detailed in your answers. ENTER MOST RECENT JOB FIRST If more space is needed please attach another page Rev. 04/10 Page 3

4 REFERENCES Name five persons not related to you who have knowledge of your qualifications for this position. NAME POSITION TITLE COMPANY PHONE In addition to the College s standard application, candidate must supply cover letter, résumé, and transcripts (if applicable). How did you first learn about this opening? (please check the primary source) IVCC Website Friend Relative Walk-in IDES Skills Match Professional Journal (indicate name of journal): Chronicle of Higher Education Newspaper Advertisement (indicate name of newspaper): Internet (indicate site): Other: I have carefully reviewed this application form and certify that the facts set forth in the employment application are accurate and complete. I understand that if the College employs me, any misrepresentation on this application will be sufficient cause for the termination of employment and/or immediate cancellation of any contract executed between the applicant and Illinois Valley Community College. I understand, however, that the College is not obligated to provide employment and that I am not obligated to accept employment. Nothing in this application is intended to create any contract of employment or to create any rights in the nature of a contract of employment and I understand my employment with the College would be at will. I, the undersigned, hereby duly authorize IVCC officials to investigate all statements in this application and included in my resume (vitae), and I authorize IVCC officials to communicate with persons listed as references, former employers, and any others with whom you desire to check. I agree to hold such persons harmless with respect to any information they may give about me. I waive any right I may have to notice from any individuals and organizations named or referred to in this application prior to the release of any employment information to the College. I hereby authorize all individuals and organizations named or referred to in this application and any law enforcement organization to give the College all information relative to such verification and hereby release such individuals, organizations and the College from any and all liability for any claim or damage resulting therefrom. I also understand that my employment with Illinois Valley Community College may be contingent upon successful completion of a criminal background investigation. I hereby acknowledge that I have read and understand the above statements. Date Signature Rev. 04/10 Page 4

5 Illinois Valley Community College 815 North Orlando Smith Avenue Oglesby, IL EQUAL EMPLOYMENT OPPORTUNITY INFORMATION REQUEST The College has a commitment to equal employment opportunity and affirmative action. To fulfill this commitment and comply with the Department of Labor reporting requirements, it is important to determine the composition of the applicant pool for each position. The following information is being collected separately and confidentially and is not a part of the regular application form. It is requested for the purpose of determining compliance with federal and civil rights law. Your response will not affect consideration of your application nor any employment decision. By providing this information, you will assist us in assuring that this program is administered in a nondiscriminatory manner. Date: Race/Ethnic Identification (check one): Position Applied For: (Please Print) 1. Are you Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race)? Yes No 2. Are you from one or more of the following racial groups? Select all that apply. American Indian or Alaska Native (Not Hispanic or Latino, a person having origins in any of the original peoples of North and South America, including Central America, and who maintain tribal affiliation or community attachment) Asian (Not Hispanic or Latino, a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam) Black or African American (Not Hispanic or Latino, a person having origins in any of the black racial groups of Africa) Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino, a person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands) White (Not Hispanic or Latino, a person having origins in any of the original peoples of Europe, the Middle East, or North Africa) Choose not to respond 3. Sex: (please check one) Male Female 4. Are you a Vietnam/Desert Storm-era veteran? 5. Citizenship: (please check one) U.S. Citizen Permanent Resident Temporary Visa Rev. 04/10 Page 5