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BROWSE PACIFIC UNION COLLEGE FORMS
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APPLICATION FOR EMPLOYMENT
Instructions for completion:
1. Save this document before proceeding.
2. Complete the application form, then
save again.
Click here begin
3. Please note: Your signature is
required at the bottom of page 4 to
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Human Resources Office
One Angwin Avenue
Angwin, CA 94508
707-965-6231
707-965-6400 (fax)
hr@puc.edu (e-mail )
Human Resources Office
One Angwin Avenue
Angwin, CA 94508
707-965-6231
707-965-6400 (fax)
hr@puc.edu (e-mail )
Please note:
Your signature is required
at the bottom of page 4 to
complete this form.
Pacific Union College
is committed to equal
employment opportunities for
all individuals. The College
does not discriminate on the
basis of race, color, sex, age,
national origin, marital status,
or disability in its employment.
The College also prohibits
harassment in the workplace.
As a religious institution,
the College does exercise its
constitutional and statutory
rights to give preference to
hiring Seventh-day Adventists.
Please complete the
application in its entirety.
A clear understanding
of your background and work
history will aid us in placing
you in the position that best
suits your qualifications.
Please use an additional sheet
if necessary to provide further
information that would assist
us in making our decision
about your application.
APPLICATION FOR EMPLOYMENT
PERSONAL HISTORY
Date:
➤ Name:
Last First Middle
Street address:
Address City State Zip
Home phone: ( ) Business phone: ( ) Fax: ( )
E-mail:
Social Security Number:
Have you used any other names for education, employment, or other purposes? Yes No
If yes, please state all names, dates used, and reasons/purpose (include preferred or nicknames):
Are you over eighteen years of age? Yes No
Do you have a valid Motor Vehicle Operator’s License?
Yes No
From what state?
Exp. date: Class:
Do you maintain automobile insurance? Yes No Insurance limits:
Person to notify in case of an emergency:
Name:
Address:
City State Zip Phone
➤ Positions applying for: (1) (2) (3)
Are you seeking and available for:
Full time Part time
Date available:
Pay expected $
Are you able to perform, with or without accommodation, the essential duties of the position for which you have applied?
Yes No
➤ Can you, after employment, submit verification of your legal right to work in the United States?
Yes No
If no, have you received employment authorization from the United States Immigration and Naturalization Service to
work in the United States?
Yes No
Would you agree to take a medical examination (after employment offer) if exam is required for this position?
Yes No
Are you a member in regular standing of the Seventh-day Adventist church?
Yes No
If yes, name of church and pastor:
Have you previously been denominationally employed?
Yes No
If yes, last employer:
Are you a former College employee?
Yes No
If yes, what department?
Do you plan to engage in other work while you are employed by the College?
Yes No
If yes, describe the employer, the nature of the work, and the hours and days of the week involved:
Can you work any day of the week if required?
Yes No If no, please explain:
211045 EMPAPP 1/12
Page 1
EDUCATION
See attached resume Use information below
Name and address of school Course(s) of study Circle last year
completed
Did you
graduate?
Degree or
diploma
Elementary 1 2 3 4 5 6 7 8 Yes No
High school 9 10 11 12
Junior college 13 14
College or University 13 14 15 16
Other (specify; e.g. business, technical, and/or graduate school, etc.)
SKILLS
➤ Business/Language/Clerical Skills: Check the box by any area in which you have had appropriate experience
Accounting Medical Terminology Computer Software/Languages:
Adding Machine PBX Database; types:
Bookkeeping Shorthand, wpm: Desktop publishing
Calculator Transcription Languages; types:
Cashier Typing, wpm: Spread Sheets; types:
Data Entry Other: Word Processing; types:
Other:
➤ Foreign Languages:
Name and address of school Speaking Reading Writing Fluency:
Advanced Basic
➤ Do you possess a professional/trade license or certificate? Yes No
Type:
Issued by: Date of Expiration:
➤ List any special job-related skills and qualifications you have obtained from employment or other experience:
Other skills?
Page 2
1
9
13
13
EMPLOYMENT HISTORY
Start with your present or most recent job including military service assignments. Account for all periods of unemployment,
including time in school or training. If you have worked for more than four employers, please use a separate sheet.
Firm name Address/City/State
Position/Department From (Mo., Yr.) To (Mo., Yr.) Hours per week
Reason for leaving
Supervisor Beginning salary Ending salary May we contact this employer now? Telephone number
Yes No
Employment status (circle one): Description of duties
Full-time Part-time PRN as needed
( )
Firm name Address/City/State
Position/Department From (Mo., Yr.) To (Mo., Yr.) Hours per week
Reason for leaving
Supervisor Beginning salary Ending salary May we contact this employer now? Telephone number
Yes No
Employment status (circle one): Description of duties
Full-time Part-time PRN as needed
( )
Firm name Address/City/State
Position/Department From (Mo., Yr.) To (Mo., Yr.) Hours per week
Reason for leaving
Supervisor Beginning salary Ending salary May we contact this employer now? Telephone number
Yes No
Employment status (circle one): Description of duties
Full-time Part-time PRN as needed
( )
➤ List any hobbies, special interests, or professional organizations:
Page 3
REFERENCES
Please list three persons, other than relatives, who have knowledge of your work experience and/or education.
Name Mailing address Phone (day) Relationship
Name Mailing address Phone (day) Relationship
Name Mailing address Phone (day) Relationship
Yes
Full-time
Full-time
Full-time
APPLICATION PROCESSING
The College does not interview all applicants for vacant job positions. Those applicants to be interviewed will be contacted
by the College. Applications will be retained for 180 days following submission. After 180 days, applicants may submit a
new application form to the College.
Applicant’s signature Date
CERTIFICATION AND CONSENT
(Please read carefully, initial each paragraph, and sign below.)
I hereby certify that I have not knowingly withheld
any information that might adversely affect my chances for
employment and that the answers given by me are true and
correct to the best of my knowledge. I have accounted for all
of my education, training, work experience, and other infor-
mation requested on this application. Information provided
on this application form and exhibits, resumes, and other
documents provided to the College is true, correct, and com-
plete. I further certify that I, the undersigned applicant, have
personally completed this application. I understand that any
false, misleading, or incomplete information, omission or
misstatement of material fact on this application or on any
document used to secure employment shall be grounds for
rejection of this application or for immediate discharge if I
am employed, regardless of the time elapsed before discovery.
I understand that I may be asked to take job-related
written and skill tests (if applicable) for the job position for
which I am applying. If I decline to be tested, I understand
that I will not be further considered for employment.
I further understand if I am employed, I will serve
an orientation period which, if successfully completed, will
change my status to regular employee.
I expressly acknowledge and understand that in the
absence of a written contract to the contrary, my status,
if I am hired, will be that of an employee at will having
no contractual right, express or implied, to remain in the
employ of Pacific Union College. In this connection,
I further expressly acknowledge that neither anything said
to me during the application and/or interview process or
during employment, nor any provision in the employee
handbook or personnel manual, constitutes the terms of
an implied employment agreement. In consideration of any
employment offered, I specifically agree that my employment
may be terminated, with or without cause or notice, at any
time, at the option of either the employer or myself.
If offered employment with the College, I understand that
I must comply with all of the College’s rules and procedures.
I hereby authorize the College to thoroughly investi-
gate my references, work record, education, and other mat-
ters related to my suitability for employment and, further,
authorize the references and prior employers I have listed to
disclose to the College any and all letters, reports, and other
information related to my work records, without giving me
prior notice of such disclosure. In addition, I hereby release
the College, my former employers, and all other persons,
corporations, partnerships, and associations from any and
all claims, demands, or liabilities arising out of or in any
way related to such investigation or disclosure.
I hereby agree to submit to binding arbitration all
disputes and claims arising out of the submission of this
application. I further agree, in the event that I am hired by
the College, that all disputes which might arise out of my
employment with the College, whether during or after that
employment, that cannot be resolved by informal internal
resolution will be submitted to binding arbitration. I agree
that such arbitration shall be conducted under the rules of
the American Arbitration Association. By initialing in the
space above, I am giving up my judicial rights to discovery
and appeal, unless such rights are specifically included in the
arbitration of disputes provision. If I refuse to submit to ar-
bitration after agreeing to this provision, I may be compelled
to arbitrate under the authority of the California Code of
Civil Procedure. My agreement to this arbitration provision
is voluntary. This application contains the entire agreement
between the parties with regard to dispute resolution, and
there are no other agreements as to dispute resolution, either
oral or written.
I have read and understand the foregoing and agree
to submit disputes arising out of this application and/or
employment with the College to neutral arbitration before
the American Arbitration Association.
Agree Do Not Agree
X
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Completed 24 August 2020

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