Fillable APPLICATION FOR EMPLOYMENT (Southern West Virginia Community and Technical College)

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APPLICATION FOR EMPLOYMENT (Southern West Virginia Community and Technical College)

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APPLICATION FOR EMPLOYMENT
Please contact the Human Resources Department if you need
assistance or reasonable accommodations in the application or
hiring process.
Department of Human Resources
P.O. Box 2900, Mount Gay, WV, 25637
PH: 304-896-7441 FAX: 304-792-7096
Position for which applying Date
Would you work full time?
If part time, specify days/hours
If yes, when?
If yes, provide name
Personal Information
Last Name
Address
City Zip Code
First Name
State
SSN
Phone Number (Day)
Phone Number(Alt)
DO NOT FILL OUT BEFORE READING
READ CAREFULLY BEFORE ANSWERING ANY QUESTIONS IN THIS BLOCKED AREA. DO NOT ANSWER ANY QUESTIONS UNLESS THE
BOX NEXT TO THE QUESTION IS CHECKED, thereby indicating that the requested information is needed for the bona fide occupational
qualification or other legally permissible reason. Conviction record will not necessarily be a bar to employment.
Have you ever been bonded or had a security clearance for a job?
If yes, explain
If yes, explain
Have you ever been convicted of a misdemeanor?
If yes, explain
Have you ever been convicted of a felony?
Policy Statement-Nondiscrimination of Basis of Sex and Equal Employment Opportunity
It is the policy of Southern West Virginia Community and Technical College, not to discriminate on the basis of sex in its education programs,
activities, employment policies, or admission of students to any program of study as required by Title IX of the 1972 Education Amendments.
Additionally, the College upholds and complies with the Civil Rights Act of 1964, as amended, which prohibits discrimination in employment
practices because of race, religion, color, national origin, ancestry, sex, age, or handicap. Inquiries regarding compliance with Title IX and/or The Civil
Rights Act may be directed to the Director of Human Resources, Southern West Virginia Community and Technical College by calling (304) 896-7408
or by contacting the Director of the Office of Civil Rights, Department of Health, Education and Welfare, Washington, D.C.
If your application is considered, what date will you be available to start?
SOUTHERN WEST VIRGINIA COMMUNITY
AND TECHNICAL COLLEGE
Which location(s) are you willing to work?
Boone Campus Lincoln Site Logan Campus Williamson Campus Wyoming/McDowell Campus Any
Yes No
Part time?
Yes No
Rate of pay expected?
Per hour Per month Per year
Have you worked for Southern before?
Yes No
Do you have a relative working for Southern?
Yes No
Are you 18 years or older?
Yes No
Yes No
Yes No
Yes No
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Print Form
Work Experience
List below all present and past employment, beginning with your most recent. List additional work experience, if necessary, on a separate sheet using the format below.
Business Name
Job Title
Address
City Zip CodeState
Starting Date of Employment
Ending Date of Employment
Name of Supervisor Supervisor's Phone
If not, who may we contact?
May we contact this person?
Reason for leaving
Phone
Describe in detail the work you did.
Describe in detail the work you did.
Business Name
Job Title
Address
City Zip CodeState
Starting Date of Employment
Ending Date of Employment
Name of Supervisor Supervisor's Phone
If not, who may we contact?
May we contact this person?
Reason for leaving
Phone
Name of Supervisor
Describe in detail the work you did.
Business Name
Job Title
Address
City Zip CodeState
Starting Date of Employment
Ending Date of Employment
Supervisor's Phone
If not, who may we contact?
May we contact this person?
Reason for leaving
Phone
Yes No
Yes No
Yes No
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Record of Education
Name
Address
City Zip Code
Major/Minor
High School
Last Year Completed
University or College
University or College
Graduate School
Business or Trade
State
Address
Name
City Zip Code
Major/Minor Degree Received
State
Address
Name
City Zip Code
Major/Minor
State
Address
Name
City Zip Code
Major/Minor
State
Address
Name
City Zip Code
Major/Minor
State
Describe below any other experiences, skills, certifications, or qualifications which you feel would especially qualify you for the position.
Type(wpm) Shorthand(wpm) Business Machines
Other Knowledge, Skills, and Abilities
If yes, in what State?
Are you licensed to drive a car?
License No.
Yes No
List Driver's License Endorsement(s) if applicable:
Degree Received
Degree Received
Degree Received
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Military Service Record
If yes, what branch?
Have you been in the U.S. Armed Forces?
From To
Dates of duty
Rank at Discharge
List duties in service, including special training (Unless listed above under Record Of Education)
Personal References
Address
Name
City Zip Code
Phone
Occupation
To Be Read And Signed By Applicant
I certify that this application was completed by me; that all entries on it and information in it are true and complete to the best of my knowledge; and that I am
currently legally eligible for employment in the United States and am prepared to present documentation to support that fact prior to an offer of employment.
I authorize you to make such investigation and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in
arriving at an employment decision. (Inquiries regarding medical history will be made only if and after conditional offer of employment has been extended.) I hereby
release employers, schools, colleges, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with
application.
In the event of employment, I understand that any falsification, omission, or misleading information given in this application or interview(s) will be grounds for
immediate dismissal. I understand that I am required to abide by all rules and regulations of the College. I understand and agree also, that my employment and
compensation can be terminated with or without notice at anytime at the option of either Southern West Virginia Community Technical College or myself.
PLEASE PRINT AND SIGN APPLICATION. MAIL OR FAX TO:
Southern West Virginia Community and Technical College
Department of Human Resources
P.O. Box 2900, Mount Gay, WV, 25637
Fax: 304-792-7096
Be sure to include copies of your college transcripts, licenses, or certifications with your application for employment.
Applicant's Signature Date
State
State
Address
Name
City Zip Code
Phone
Occupation
State
Address
Name
City Zip Code
Phone
Occupation
Yes No
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APPLICATION FOR EMPLOYMENT (Southern West Virginia Community and Technical College)

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Completed 4 February 2021

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