Fillable 2108 S. Horton Fort Scott, KS 66701 www.fortscott.edu (Fort Scott Community College)

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2108 S. Horton Fort Scott, KS 66701 www.fortscott.edu (Fort Scott Community College)

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  • 10 check-boxes
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Country of origin: US
File type: PDF

U.S.A. forms for Fort Scott Community College

BROWSE FORT SCOTT COMMUNITY COLLEGE FORMS
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Page 1 of 3
Date:
Name:
Address:
City State Zip
Telephone:
Email Address:
Full Time
Yes No
Yes No
Position Desired:
Minimum Salary Requirement:
Are you legally eligible for employment in the United States?
Have you ever been convicted of a crime other than traffic violation?
Does your driving record have issues that would prevent you from
being an insured driver at FSCC?
Yes
No
(A conviction will not automatically bar you from employment)
If Yes, please provide the date and disposition.
Does Fort Scott Community College have permission to investigate your background? Yes No
EDUCATION
** Copies of transcripts required for all faculty applications.
Other Specialized or Technical Training Not Listed Above:
License, Certifications, and Registrations Not Listed Above:
Street
Cell
Home
Date Available for Work:
Part Time
High School
2108 S. Horton Fort Scott, KS 66701
www.fortscott.edu
Vocational or Trade
School
Comm
unity College
Undergraduate
University
Graduate School
Diploma/Degree
Field of Study
School Name & Location
Page 2 of 3
WORK EXPERIENCE (most recent job first)
Employer:
Address: Mo./Yr.
Telephone:
Salary:
Reason For Leaving:
Employer:
Address: Mo./Yr.
Telephone:
Salary:
Reason For Leaving:
Employer:
Address: Mo./Yr.
Telephone:
Salary:
Reason For Leaving:
Employer:
Address: Mo./Yr.
Telephone:
Salary:
Reason For Leaving:
REFERENCES
Start
End
Employment Dates
Start
End
Employment Dates
Start
End
Start
End
Employment Dates
Start
End
Start
End
Employment Dates
Start
End
Start
End
May we contact this employer?
May we contact this employer?
May we contact this employer?
May we contact this employer?
NAME
Title
Phone
Address
Page 3 of 3
Signature of Applicant Date
It is
understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation
of this application and/or separation from the employer's service if I have been employed. I give the employer the right to
investigate all references and to secure additional information about me, if job related. I understand that, if hired, I will be
required to provide verification of employee eligibility. I have read, or have had read to me, the above statements. By my
signature, I understand and agree to these provisions.
NOTICE OF NON-DISCRIMINATION
In accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title II of the
Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, Title IX of the Education Amendments Act of 1972, and the
Regulations of the U.S. Department of Health and Human Servi
ces issued pursuant to these statutes at Title 45 Code of Federal
Regulations (CFR) Parts 80, 84, and 91, and 28 CFR Part 35. Fort Scott Community College does not discriminate on the basis of any
characteristic protected by law (such as sex, disability, age, race, color, or national origin) in all aspects of employment, admission, and
participation in its education programs or activities. Inquiries concerning Fort Scott Community College’s compliance under these laws,
should be directed to contact the College's Compliance Officer/Human Resources Director, Fort Scott Community College, Fort Scott,
Kansas 66701 (620) 223-2700.
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2108 S. Horton Fort Scott, KS 66701 www.fortscott.edu (Fort Scott Community College)

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Completed 3 February 2021

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