KIRTLAND COMMUNITY COLLEGE
10775 North St. Helen Road
Roscommon, MI 48653
Fax: 989-275-8210
Email: hr@kirtland.edu
APPLICATION FOR CLASSIFIED EMPLOYMENT
PERSONAL INFORMATION
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? Yes No
Email:
Position Desired
When can you begin work?
Are you available for full-time employment? Yes No
Are you available for part-time employment? Yes No
Are you authorized to work in the US?
Yes No
Other special training or skills (machine operation, typing speed, office skills, etc.)
EDUCATION
SCHOOL NAME AND LOCATION
COURSE OF STUDY
YEARS
COMPLETED
DID YOU
GRADUATE?
College
Yes
No
Business/
Trade/
Technical
Yes
No
High School
Yes
No
Reset Form
EMPLOYMENT HISTORY
Please provide accurate, complete full-time and part-time employment record beginning with your present or most recent employer
Company Name
Telephone
( )
Address
Dates of employment (month/year)
From To
Name of Supervisor
Full-time Part-time
Job Title
Reason for leaving
Company Name
Telephone
( )
Address
Dates of employment (month/year)
From To
Name of Supervisor
Full-time Part-time
Job Title
Reason for leaving
Company Name
Telephone
( )
Address
Dates of employment (month/year)
From To
Name of Supervisor
Full-time Part-time
Job Title
Reason for leaving
Company Name
Telephone
( )
Address
Dates of employment (month/year)
From To
Name of Supervisor
Full-time Part-time
Job Title
Reason for leaving
We may contact the employers listed above
unless you indicate those you do not want us to
contact.
DO NOT CONTACT
Employer
Reason
MILITARY
Did you serve in the US Armed Forces? Yes No
If yes, in what branch?
Describe any training received relevant to the position for which you are applying:
MEMBERSHIP IN JOB-RELATED PROFESSIONAL ORGANIZATIONS
(Exclude those which may disclose your race, color, religion or national origin)
REFERENCES
Name Address Phone Number
( )
Name Address Phone Number
( )
Name Address Phone Number
( )
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
The college’s annual security report is available upon request.
For a copy, contact 989-275-5000, ext. 283
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