KIRTLAND COMMUNITY COLLEGE
10775 N. ST. HELEN ROAD
ROSCOMMON, MI 48653
APPLICATION FOR ADMINISTRATIVE POSITION
PERSONAL
Last Name First Middle Date
Street Address Home Phone Number
( )
City, State, Zip Code Business phone number
( )
Have you ever applied for employment at Kirtland?
G
yes
G
no When can you begin work?
Position Desired
Are you authorized to work in the United States?
G
yes
G
no

EDUCATION
SCHOOL NAME AND LOCATION
OF SCHOOL
COURSE OF
STUDY
NO. OF
YEARS
COMPLETED
DID YOU
GRADUATE?
DEGREE
EARNED
Undergraduate
College
G
Yes
G
No
Graduate
School
G
Yes
G
No
Graduate
School
G
Yes
G
No
HONORS AND AWARDS
Reset Form
TEACHING HISTORY
List all teaching positions held in reverse chronological order.
SCHOOL OR
COLLEGE
LOCATION POSITION SUBJECT
TAUGHT
LEVEL OF
INSTRUCTION
NO.
YEARS
DATES
EDUCATIONAL ADMINISTRATIVE HISTORY
List all educational administrative positions held in reverse chronological order
SCHOOL OR COLLEGE LOCATION POSITION NO. OF
YEARS
DATES OF
EMPLOYMENT
PROFESSIONAL OR CIVIC ACTIVITIES
ORGANIZATION YEARS ORGANIZATION YEARS
MILITARY
Did you serve in the U.S. Armed Forces?
G
Yes
G
No If yes, in what branch?
Describe any training received relevant to the position for which you are applying:
REFERENCES
List a minimum of four references that may be contacted regarding your character and ability as an administrator
Name Address and Phone Number Business/Profession and title
Name Address and Phone Number Business/Profession and title
Name Address and Phone Number Business/Profession and title
Name Address and Phone Number Business/Profession and title
May we contact your present employer?
G
Yes
G
No
TRANSCRIPTS AND CREDENTIALS
: This application is not considered complete until official transcripts and credentials (your
professional biography) are on file at the college. Interviews will be arranged only after the application is complete.
APPLICANT SIGNATURE
The information provided in this application for employment is true, correct and complete. If employed, any misstatement or
omission of fact on this application may result in my immediate dismissal. I understand that acceptance of an offer of
employment does not create a contractual obligation upon the employer to continue to employ me in the future.
Date Signature
Kirtland Community College is an Equal Opportunity Employer
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