Fill - APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT

Central Methodist University is an Equal Opportunity Employer. It is the policy of CMU to ensure equal employment

opportunities for all applicants and employees in regards to our employment practices. Personnel policies and procedures

are designed and administered without regard to race, religion, color, sexual preference, ethnicity, disability, genetic

information, age, sex, or any other protected class, except where age or sex is a bona fide occupational qualification.

Position(s) applied for: ____________________________________________ Date: __________________________

Personal Information

First Name: ____________________________________ Last Name: ___________________________________

Address: ______________________________________ Email Address: ________________________________

City: _________________________________________________________________________

State: _____________________________________ Zip Code: __________________________

Mobile Phone: _______________________________ Work Phone: _______________________________

(check your preference)

Are you now or have you been employed by Central Methodist University? Yes No

If yes, list dates: _________________________________________________________

Are you related to anyone currently employed by Central Methodist University? Yes No

If yes, list name and relationship: ____________________________________________

Are you authorized to work in the United States? Yes No

If employed, you must show documents that prove your identity and employment eligibility

Will you now or in the future require sponsorship for employment visa status (e.g.H-1Bvisa status)? Yes No

Have you ever been convicted of a crime other than a minor traffic violation? Yes No

If yes, please explain: ____________________________________________________________

(Disclosure of a criminal record will not necessarily disqualify you from employment consideration. Each offense will be

evaluated on its own with respect to time, circumstance and seriousness in relation to the job for which you are applying.)

Do you currently hold a valid driver license? Yes No

Educational Record

High School

Name & Address: ____________________________________________________________________________

Course of Study: ____________________________________________________________________________

Years Completed: ________________________ Diploma/Degree: _____________________________________

Vocational / Technical

Name & Address: ____________________________________________________________________________

Course of Study: ____________________________________________________________________________

Years Completed: ________________________ Diploma/Degree: _____________________________________

College

Name & Address: ____________________________________________________________________________

Course of Study: ____________________________________________________________________________

Years Completed: ________________________ Diploma/Degree: _____________________________________

Other

Name & Address: ____________________________________________________________________________

Course of Study: ____________________________________________________________________________

Years Completed: ________________________ Diploma/Degree: _____________________________________

Related Skills/Certifications List technical or specialized skills relevant to this position

__________________________________________________________________________________________

Employment History

List ALL relevant employment history starting with the most current position held, including any volunteer experience or

experience obtained in military service. Please explain gaps in employment. You may attach a resume, but you must

complete the employment section in its entirety. Failure to answer all items in the following section may eliminate you from

further consideration.

Most Recent Employer

Name: _____________________________________________________________________________________

Job Title: __________________________________________________________________________________

Address: _____________________________________________________ Telephone: ____________________

Name and Title of Supervisor: __________________________________________________________________

Dates Employed _______________________________ Salary: _______________________________________

Reason for Leaving: __________________________________________________________________________

May we contact for references? Yes No

Describe your duties in detail: __________________________________________________________________

Previous Employer

Name: _____________________________________________________________________________________

Job Title: __________________________________________________________________________________

Address: _____________________________________________________ Telephone: ____________________

Name and Title of Supervisor: __________________________________________________________________

Dates Employed _______________________________ Salary: _______________________________________

Reason for Leaving: __________________________________________________________________________

May we contact for references? Yes No

Describe your duties in detail: __________________________________________________________________

Previous Employer

Name: _____________________________________________________________________________________

Job Title: __________________________________________________________________________________

Address: _____________________________________________________ Telephone: ____________________

Name and Title of Supervisor: __________________________________________________________________

Dates Employed _______________________________ Salary: _______________________________________

Reason for Leaving: __________________________________________________________________________

May we contact for references? Yes No

Describe your duties in detail: __________________________________________________________________

Professional References

(Please list three people that can attest to your skills and abilities relating to the position applied for)

Reference 1

Name & Position: _________________________________________________________________________

Organization Address: ________________________________________________________________________

Phone Number: _________________________ Email: ______________________________________________

Reference 2

Name & Position: _________________________________________________________________________

Organization Address: ________________________________________________________________________

Phone Number: _________________________ Email: ______________________________________________

Reference 3

Name & Position: _________________________________________________________________________

Organization Address: ________________________________________________________________________

Phone Number: _________________________ Email: ______________________________________________

PLEASE READ CAREFULLY AND SIGN – I certify that all information I have provided on this application is true

and complete to the best of my knowledge and that I have withheld nothing which, if disclosed, would affect this

application unfavorably. I understand that the willful omission of pertinent material facts or falsification of any

information in this application is grounds for refusal to hire me or termination without notice.

I understand and agree that neither this document nor any offer of employment from Central Methodist University

constitutes an employment contract unless a specific document to that effect is executed in writing. If an employment

relationship is established, I understand that both Central Methodist University and I may terminate my employment at

any time for any reason. For all purposes, I will be an “at-will” employee. The “at-will” status can be changed only by a

written agreement signed by the President. No employee, manager or other agent of the University has the authority to

enter into any agreement, oral, written or otherwise, which alters the at-will policy.

I authorize Central Methodist University to make such investigations and inquiries of my personal, employment, financial,

driving, or criminal history and other matters related to verifying information on this application as may be necessary in

arriving at an employment decision. I hereby release Central Methodist University, employers, schools, or persons from

all liability in responding to inquiries in connection with my application.

I acknowledge that by typing my name, it will serve as my signature

Applicant’s Signature: __________________________________________ Date: ___________________

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