Fill - Free fillable APPLICATION FOR EMPLOYMENT COAHOMACOMMUNITYCOLLEGE OFFICEOFHUMANRESOURCES Weconsiderapplicantsforallpositionswithoutregardtorace,color,religion,creed,gender, nationalorigin,age,disability,maritalorvet PDF form

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(PLEASEPRINT)

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LastNameFirstNameMiddleName

Address Number StreetCity  State ZipCode

TelephoneNumber(s) SocialSecurityNumber(voluntary)



Besttimetocontactyouathomeis:



____:________

AMPM

Ifyouareunder18yearsofage,canyouproviderequiredproofofyoureligibilitytowork? Yes No

Haveyoueverfiledanapplicationwithusbefore?IfYes,givedate___________________ Yes No

Haveyoueverbeenemployedwithusbefore?IfYes,givedate______________________ Yes No

Doanyofyourf

riendsorrelatives,otherthanspouse,workhere?

IfYes,statename,relationshipandlocation______________________________________

Yes No

Areyoucurrentlyemployed? Yes No

Maywecontactyourpresentemployer? Yes No

AreyoupreventedfromlawfullybecomingemployedinthiscountrybecauseofVisaorImmigrationStatus?

Proofofcitizenshiporimmigrationstatu

swillberequireduponemployment.

Yes No

Dateavailableforwork_____/_____/_____ Whatisyourdesiredsalaryrange?_____________

Areyouavailabletowork: FullTime (Pleaseindicate123shift)

 PartTime (PleaseindicateMorningsAfternoonEvenings)

 Temporary (Pleaseindicatedatesavailable____/

____‐____/____)

Areyoucurrentlyon“lay‐off”statusandsubjecttorecall?

Yes No

Canyoutravelifajobrequiresit?

Yes No

EDUCATION

School NameandAddressofSchool CourseofStudy

No.ofYears

Completed

Diploma/Degree

HighSchool



UndergraduateCollege



Graduate/Professional



Other(Specify)



ADDITIONAL INFORMATION

tateanyadditionalinformationyoufeelmay behelpfultousinconsideringyourapplication,includinganyjobrelatedtrainingintheU.S.Military.

____________________________________________________________________________________________________________

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NotetoApplicants:DONOTANSWERTHISQUESTIONUNLESSYOUHAVEBEENINFORMEDABOUT THEREQUIREMENTSOFTHEJOBFORWHICHYOUARE

APPLYING.Areyoucapableofperforminginareasonablemanner,withorwithoutareasonableaccommodation,theactivitiesinvolvedinthejoboroccupation

forwhichyouhaveapplied?Arevie

woftheactivitiesinvolvedinsuchajoboroccupationhasbeengiven.  ____YES____NO

WEAREANEQUALOPPORTUNITYEMPLOYER

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Position(s)AppliedFor DateofApplication

HowDidYouLearnAboutUs?

Advertisement Friend Inquiry EmploymentAgency Relative Other_______________________

APPLICATION

FOR EMPLOYMENT

COAHOMACOMMUNITYCOLLEGE

OFFICEOFHUMANRESOURCES 

3240FRIARSPOINTROAD

CLARKSDALE,MISSISSIPPI38614

PHONE:662‐627‐2571 FAX:662‐627‐9451

Weconsiderapplicantsforallpositionswithoutregardtorace,color,religion,creed,gender,

nationalorigin,age,disability,maritalorveteranstatus,oranyotherlegallyprotectedstatus.

Print Form

WORK EXPERIENCE

Startwithyourpresentorlastjob.Includeanyjob‐relatedmilitaryserviceassignmentsandvolunteeractivities.Excludeorganizationswhichindicaterace,color

religion,gender,nationalorigin,disabilitiesorotherprotectedstatus.

Employer

DatesEmployed

WorkPerformed

Address From To



TelephoneNumber(s)

HourlyRates/Salary 

Starting/PresentJobTitle Starting Final



Supervisor

ReasonforLeaving

MayWeContact Yes  No

Employer

DatesEmployed

WorkPerformed

Address From To



TelephoneNumber(s)

HourlyRates/Salary 

Starting/PresentJobTitle Starting Final



Supervisor

ReasonforLeaving

MayWeContact Yes  No

Employer

DatesEmployed

WorkPerformed

Address From To



TelephoneNumber(s)

HourlyRates/Salary 

Starting/PresentJobTitle Starting Final



Supervisor

ReasonforLeaving

MayWeContact Yes  No

PERSONAL/PROFESSIONALREFERENCES

Donotincludefamilymembersorpastsupervisors.

Name PhoneNumber BestTimetoCall Occupation

1.



2.



3.



APPLICANT’SSTATEMENT

Icertifythatanswersgivenhereinaretrueandcomplete.



Iauthorizeinvestigationofallstatementscontainedinthisapplicationforemploymentasmaybenecessaryinarrivingatanemploymentdecision.



Thisapplicationforemploymentshallbeconsideredactiveforaperiodoftimenottoexceed45days.Anyappl

icantwishingtobeconsideredforemployment

beyondthistimeperiodshouldinquireastowhetherornotapplicationsarebeingacceptedatthattime.

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Iherebyunderstandandacknowledgethat,unlessotherwisedefinedbyapplicablelaw,anyemploymentrelationshipwiththisorganizationisofan“atwill”nature,

whichmeansthattheEmploye

emayresignatanytimeandtheEmployermaydischargeEmployeeatanytimewithorwithoutcause.Itisfurtherunderstoodthat

this“atwill”employmentrelationshipmaynotbechangedbyanywrittendocumentorbyconductunlesssuchchangeisspecificallyacknowledgedinwr

itingbyan

authorizedexecutiveofthisorganization.



Intheeventofemployment,Iunderstandthatfalseormisleadinginformationgiveninmyapplicationorinterview(s)mayresultindischarge.I understand,also,that

IamrequiredtoabidebyallrulesandregulationsoftheEmployer.



_________________________________________

SignatureofApplicant

__________________________

Date

Rev7/99

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APPLICATION FOR EMPLOYMENT COAHOMACOMMUNITYCOLLEGE OFFICEOFHUMANRESOURCES Weconsiderapplicantsforallpositionswithoutregardtorace,color,religion,creed,gender, nationalorigin,age,disability,maritalorveteranstatus,oranyotherlegallyprotectedstatus. (Coahoma C

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