Fillable APPLICATION FOR EMPLOYMENT (Luna Community College)

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APPLICATION FOR EMPLOYMENT (Luna Community College)

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APPLICATION FOR EMPLOYMENT
LCCEmploymentApplication2018 Page 1 of 4
EQUAL EMPLOYMENT OPPORTUNITY: Luna Community College (LCC) is an equal employment
opportunity / affirmative action employer. All applicants will receive consideration for employment
regardless of race, color, religion, gender, age, marital status, national origin, citizenship status,
disability, or veteran status.
ESSENTIAL INFORMATION: All portions of this application that are applicable to you must be
completed. Please do not indicate, “refer to resume”. A completed application package includes the
following: 1) Completed Application Form (Applicants Are Required to Provide Official
Documentation Confirming Education) 2) Letter of Interest and 3) Current Resume.
PERSONAL INFORMATION
Last Name First Name Middle Initial
Social Security Number
Current Address: Street City State Zip Code
Phone Number: Alternate Phone Number
Position Applying For ________________________________________________
Are you seeking: _____ Full Time Employment _____ Part Time Employment _____Temporary Employment
Are you currently employed: _____ Yes _____ No Date you are available to Start: _______________
GENERAL INFORMATION
1. Do you have relatives working for Luna Community College? If yes, who and in what capacity. _____ Yes _____ No
2. Are you related to any member of the LCC Board of Trustees? If yes, who and in what capacity. _____ Yes _____No
______________________________________________________________________________________________________
3. Are you 18 years of age or older? _____ Yes _____ No
4. If you become employed by LCC, can you furnish proof that you are eligible to work in the U.S.? _____ Yes _____ No
5. Can you perform the essential functions of the job you are applying for with or without reasonable accommodations?
_____ Yes _____ No
6. Have you ever worked for LCC? If so, provide dates of employment and position. _____ Yes _____ No
7. Do you have a valid New Mexico Driver’s License? ____Yes _____No
(State any restrictions or conditions)
APPLICATION FOR EMPLOYMENT
LCCEmploymentApplication2018 Page 2 of 4
EDUCATION: Do you have a high school diploma or equivalency? ____Yes ____ No
List all schools attended beyond high school and their location:
Major
Degree
Major
Degree
Major
Degree
List any courses, vocational training, licenses, certificates, or other qualifications which bear on your suitability for this position:
COMPLETE ONLY IF APPLICABLE TO POSITION
Typing: Yes No _____ WPM Word Processing: Yes No
10-key: Yes No Spreadsheets: Yes No
Personal Computer Yes No
List Specific Software Programs:
________________________________________________
________________________________________________
________________________________________________
List Other Office Equipment and/or Software Programs which
bear on you suitability for this position:
_____________________________________________________
_____________________________________________________
_____________________________________________________
WORK EXPERIENCE — A RESUME DOES NOT SUBSTITUTE
What you write in this section is used to decide if you meet the minimum qualifications for the position announcement.
Please account for all time. Include periods of unemployment, volunteer positions (unpaid and job related experience),
internships, military service and any prior employment with LCC. Please begin with your most recent job. If you have
employment gaps of six months or greater, please date and sign an attached written explanation for gap.
Employer
Employer’s Address & Telephone Number:
Type Of Business:
Your Job Title
From (Month/Year)
To (Month/Year):
Name of Supervisor
Beginning Salary Ending Salary Full-Time Part-Time
Reason For Leaving:
Briefly describe your job duties as they relate to the position you are applying for:
Employer
Employer’s Address & Telephone Number:
Type Of Business:
Your Job Title
From (Month/Year)
To (Month/Year):
Name of Supervisor
Beginning Salary Ending Salary Full-Time Part-Time
Reason For Leaving:
Briefly describe your job duties as they relate to the position you are applying for:
APPLICATION FOR EMPLOYMENT
LCCEmploymentApplication2018 Page 3 of 4
Employer
Employer’s Address & Telephone Number:
Type Of Business:
Your Job Title
From (Month/Year)
To (Month/Year):
Name of Supervisor
Beginning Salary Ending Salary Full-Time Part-Time
Reason For Leaving:
Briefly describe your job duties as they relate to the position you are applying for:
Employer
Employer’s Address & Telephone Number:
Type Of Business:
Your Job Title
From (Month/Year)
To (Month/Year):
Name of Supervisor
Beginning Salary Ending Salary Full-Time Part-Time
Reason For Leaving:
Briefly describe your job duties as they relate to the position you are applying for:
REFERENCES: Please provide the name, address, job title and work telephone number of three persons who can verify
employment dates, position held, job duties, etc…
_______________________________________ ________________________________ _______________________
1. Name and Title Address Work Phone
_______________________________________ ________________________________ _______________________
2. Name and Title Address Work Phone
_______________________________________ ________________________________ _______________________
3. Name and Title Address Work Phone
Please provide the name, address, and telephone number of two persons who are not related to you, who can attest to your
character and have knowledge of your experience and suitability for the position you are applying for:
_______________________________________ ________________________________ _______________________
1. Name Address Work Phone
_______________________________________ ________________________________ _______________________
2. Name Address Work Phone
It is important that you read the section below carefully and understand its content before you sign and initial this employment
application form.
1. I acknowledge that I have been advised that LCC is an Equal Opportunity Employer and does not
discriminate against persons regardless of race, color, religion, gender, age, marital status, national
origin, citizenship status, disability, or veteran status.
_______
Initial
2. I understand that LCC is not obligated to offer the position to me even after completing this application or
following a job interview.
_______
Initial
APPLICATION FOR EMPLOYMENT
LCCEmploymentApplication2018 Page 4 of 4
3. I officially state that answers provided in this application and in any other form, oral or written, are true and
complete to the best of my knowledge. I understand that any misstated, misleading, incomplete, or false
information is grounds for rejection and destruction of this application, refusal to hire, withdrawal of an offer
of employment or immediate discharge without recourse, whenever and however discovered.
_______
Initial
4. I understand that nothing in the application is intended to imply or create an employment relationship or
contract for employment.
_______
Initial
5. I understand and agree that in the event I am hired, that in accordance with Federal law individuals must
provide to an employer, documented proof that they are authorized to work in the United States. This proof
must be provided and verified by the LCC at the time of hire or no later than three business days after the
date of hire.
_______
Initial
6. I authorize Luna Community College to investigate all statements made in my application for employment,
and to discuss the results with those responsible for making the hiring decision. I also authorize LCC to
contact my former employers, and any listed references or other persons who can verity information.
Further, I release from liability and hold harmless such employer(s) and individuals and Luna Community
College from any harm arising from such reference checks.
_______
Initial
7. I have applied for employment with Luna Community College and might be extended a conditional offer of
employment. I understand that as a condition of my being considered for employment, I agree to undergo a
Pre-Employment Drug and Alcohol Screening. I understand that if my test results are positive, I shall not be
considered further by Luna Community College.
_______
Initial
Note: Application materials cannot be returned and LCC cannot make copies. Please keep a copy of all materials
submitted. A separate application (or copy of an application) is required for each position for which you want to
be considered.
I have read and understand the terms and conditions of this employment application.
__________________________________________
Applicant Name (Printed)
__________________________________________ _______________________________
Applicant Signature Date
Thank You For Considering
Luna Community College!
Send Application, Letter Of Interest, Current Resume, And
Official Documentation Confirming Education To:
Luna Community College
Human Resources Department
366 Luna Drive, Las Vegas, New Mexico 87701
Employment Applications May Be Obtained By Calling
(505) 454-2503
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Completed 26 July 2020

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