Fillable APPLICATION FOR EMPLOYMENT (Western Nebraska Community College)

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APPLICATION FOR EMPLOYMENT (Western Nebraska Community College)

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APPLICATION FOR EMPLOYMENT
ALLIANCE * SCOTTSBLUFF * SIDNEY
Federal law obligates us to provide reasonable accommodation to the known disabilities of applicants and
employees, unless to do so would pose an undue hardship. Please feel free to inform the Western Nebraska
C
ommunity College representative if you need an accommodation to complete the application process.
PLEASE PRINT
Date of Application Position(s)
Name
Last First Middle
Address
Street Number & Street City State Zip
Home Phone Cell Phone
Have you filed an application here before? Yes No If yes, when?
Have you ever been employed here before? Yes No If yes, when?
Are you 18 years of age or older? Yes No
Are you prevented from lawfully becoming employed in this country? Yes No If hired, you will be required to submit
documents sufficient to establish employment authorization and identity in compliance with the immigration Reform and Control Act of
1986. While you need not provide this proof of citizenship or immigration status at the time you are interviewed, please be prepared to
assure us that you can do so immediately upon being hired.
On what date would you be available for work? ________________________ Expected salary: _____________________________
Are you available to work: Full-time Part-time Temporary What days? S M T W T F S
Are you on lay-off and subject to recall? Yes No
Veteran of the U.S. military service? Yes No If yes, branch: ___________________________________
List professional, trade, business or civic activities and offices held. (You may exclude those which indicate race, color, disability, religion,
gender, or national origin):
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
EMPLOYMENT EXPERIENCE
List each job held during the last ten (10) years. Start with your present or last job. Include military service assignments and volunteer
activities. (Exclude groups which indicate race, color, religion, disability, gender, or national origin.)
Employer
Dates
Responsibility/Work Performed
From
To
Address
City, State, Zip Code
Job Title
Hourly Rate/Salary
Starting
Final
Supervisor
Reason for Leaving
Employer
Dates
Responsibility/Work Performed
From
To
Address
City, State, Zip Code
Job Title
Hourly Rate/Salary
Starting
Final
Supervisor
Reason for Leaving
Employer
Dates
Responsibility/Work Performed
From
To
Address
City, State, Zip Code
Job Title
Hourly Rate/Salary
Starting
Final
Supervisor
Reason for Leaving
Employer
Dates
Responsibility/Work Performed
From
To
Address
City, State, Zip Code
Job Title
Hourly Rate/Salary
Starting
Final
Supervisor
Reason for Leaving
EDUCATION
Please list education or specialized experience which relates to the position(s) for which you are applying. Exclude names or terms which
indicate, for example, race, color, religion, gender, disability or national origin.
School Name
High School
College/University
Graduates/Professional
Years completed (circle)
9 10 11 12
1 2 3 4
1 2 3 4
Diploma/Degree
Describe course of study
Describe specialized training,
apprenticeship, skills or extra-
curricular activities.
Name:
Location:
Length of course:
Was course completed?
Subject:
General:
Honors received: ______________________________________________________________________________________________
_____________________________________________________________________________________________________________
Special skills and qualifications, including those acquired from employment, education and other experience:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Equipment, software, or materials experience: _______________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
REFERENCES
Please list the names of three individuals who are familiar with your recent work; including your most recent supervisor; exclude any
relatives.
Name
Area Code
Phone Number
Address:
Include city, state and zip code
State any additional information you feel may be helpful in considering your application: _____________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
APPLICANT’S STATEMENT
These answers are true and complete to the best of my knowledge. The College may investigate all statements contained in this
application and I understand that my false or misleading information provided during the application or interview process will result in
my immediate discharge if I am hired, regardless of when discovered. I understand that this application is not a contract of employment.
I also understand that if hired, regardless of any oral representations to the contrary, the employment relationship between me and the
College is terminable-at-will so that both the College and I remain free to choose to end our working relationship at any time for any or
no reason. Any changes in this employment relationship must be made in writing by the College president. I also understand that any
offer of employment may be conditioned upon a health evaluation by a doctor selected by the College to determine whether I can perform
the job duties. In addition, I understand a drug and alcohol test may be required depending upon college policy. I authorize the College
to make a thorough investigation of my past employment, education and job-related activities, and I release from all liability any person,
company, or organization supplying such information. I also indemnify the College against any liability which might result from making
such investigation.
Additionally, I authorize the College to supply my employment record, in its sole discretion, in whole or in part, to any prospective
employer, government agency, or other party, with an interest that the College deems appropriate.
Signature of Applicant _____________________________________ Date ____________________________________
NOTICE OF COMBINED ANNUAL SECURITY AND FIRE SAFETY REPORT AVAILABILITY
WNCC is committed to assisting all members of the College community make informed decisions about their
personal safety. In compliance with federal law, the College prepares and distributes an Annual Security
Report that indicates the institution’s safety and security policies, procedures and crime statistics. The annual
security and fire safety compliance document is available on WNCC’s website at http://www.wncc.edu/about-
wncc/campus-safety. If
you would like a paper copy of this report, you can receive a copy at the Student
Services Office at 1601 E. 27
th
, Scottsbluff, NE 69361 or by calling 308.635-6104.
R
ETURN
A
PPLICATION
B
Y
:
Mail
Email
Fax
Human Resources
Western Nebraska Community College
1601 East 27
th
Street
Scottsbluff, NE 69361-1899
hrdirector@wncc.edu
308.635.6161
Western Nebraska Community College does not discriminate on the basis of race, color, religion, national origin, sex or
gender, age,
disability, marital status, military veteran status, sexual orientation, gender expression/identity, or political
affiliation, in its policies, practices, and activities related to employment, admissions, educational services/programming,
student services/activities, or financial aid; as expressly prescribed by Institutional policy, state and federal laws, regulations,
and executive orders. Inquiries concerning the application of these policies, laws, and/or regulations to the College may be
directed to the College's Compliance Officer for the Civil Rights Act(s), Title IX of the Education Amendments of 1972,
Americans with Disabilities Act(s), and Section 504 of the Rehabilitation Act of 1973; Kathy Ault, Human Resources
Executive Director, 1601 East 27th Street, Scottsbluff, NE 69361-1815; aultk@wncc.edu; 308.635.6350 or to the Director,
Office of Civil Rights, U.S. Department of Education, One Petticoat Lane, 1010 Walnut Street, Suite 320, Kansas City, MO,
64106-2106.
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APPLICATION FOR EMPLOYMENT (Western Nebraska Community College)

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Completed 26 July 2020

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