Alabama Community College System
Application No.
APPLICATION FOR EMPLOYMENT
GADSDEN STATE COMMUNITY COLLEGE
Position
Information
Title of position for which you are applying:
Date of Application
Personal
Information
Last Name First Name Middle Initial
Address City State Zip
Contact Information
Phone: Home Work Cell E-mail Address
Secondary and
Postsecondary Education
School/College Dates Attended
From / To
Major Minor Degree(s)
Earned
High
School/
GED
College
College
College
Other
(Specify)
Additional
infromation
Are you currently employed or have been employed within the last twelve months at an Alabama
Community College System college?
Yes No
If yes, list the name of the college(s) and dates: ____________________________________________________
Employment History
Please list most recent employment experience first.
Employer Telephone Number Job Duties
Address Dates of Employment
Title Full-time Part-time
Hr. Rate/Salary (optional)
Reason for Leaving
Employment History
(Continued)
Employer Telephone Number Job Duties
Address Dates of Employment
Title Full-time Part-time
Hr. Rate/Salary (optional)
Reason for Leaving
Employment History
(Continued)
Employer Telephone Number Job Duties
Address Dates of Employment
Title Full-time Part-time
Hr. Rate/Salary (optional)
Reason for Leaving
Employment History
(Continued)
Employer Telephone Number Job Duties
Address Dates of Employment
Title Full-time Part-time
Hr. Rate/Salary (optional)
Reason for Leaving
Employment History
(Continued)
Employer Telephone Number Job Duties
Address Dates of Employment
Title Full-time Part-time
Hr. Rate/Salary (optional)
Reason for Leaving
May we contact your current employer? Yes No
Skills, Awards,
Certificates or
Professional
Activities
Note: Please provide details of each. May use a separate sheet if necessary.
References
Please list three references, other than relatives, who can provide information verifying qualifications,
character, or work experience.
Name and Title Address Phone Number
Family
Relationship
For the purposes of disclosure, relative includes any person related within the fourth degree of affinity or
consanguinity to any job, position, or office of profit with state or with any of its agencies.
Are you a relative of any employee in the Alabama Community College system, including (name of college), or
any member of the Alabama Community College System Board of Trustees? Yes No
If yes, list the name(s), relationship, and employer/position of relative(s):
Felony
Conviction(s)
Have you ever been convicted of or pled no contest or guilty to any felony or any crime involving theft,
dishonesty, violence, or sexual misconduct? Yes No
If yes, explain below:
Consent Agreement
I represent and warrant that the information I have given on this application is full and true to the best of my knowledge and
belief. I further acknowledge that I understand that I must provide documented verification of education, experience, and
required certifications and/or licensures. And further, I represent and warrant that I have answered fully and truthfully all
questions regarding criminal convictions/records. I understand that any offer of employment is contingent upon a
satisfactory criminal background investigation and I hereby authorize my employing authority within the Alabama
Community College System and/or its assigns to conduct a criminal background history investigation. I understand
that in the event a conviction for a felony or any crime involving moral turpitude is found that the procedures
established for the Board of Trustees policy concerning criminal background checks will be followed. I further
understand that I will be responsible for the cost of said criminal background check. I hereby expressly request, and
give permission to, former employers and any persons who may have pertinent information concerning this application to
furnish such information to college officials. I agree to hold such persons harmless, and I do hereby release them from any
and all liability for damage of any nature whatsoever for furnishing such information. I understand that failure to provide full
and true information on this application may result in disqualification or dismissal.
Signature of Applicant Date
Are you a member of the Alabama Community College System Applicant Pool? Yes No
Gadsden State Community College
Attention: Human Resources
P.O. Box 227
Gadsden, AL 35902-0227
Phone: (256) 549-8235 Fax: (256) 439-6812
It is the policy of the Alabama Community College System, including all postsecondary community and technical colleges under the control of the Alabama
Community College System Board of Trustees, that no employee or applicant for employment or promotion, on the basis of any impermissible criterion or
characteristic including, without limitation, race, color, national origin, religion, marital status, disability, sex, age, or any other protected class as defined by
federal and state law, shall be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program, activity, or
employment. (Each institution will make reasonable accommodations for qualified disabled applicants or employees.)
The following information is gathered solely for reporting purposes and will not be used to evaluate the
applicant’s
qualifications, suitability, or desirability for employment.
Name:
Last First Middle
Date of Birth Social Security Number
Are you Hispanic or Latino? Yes No
Ethnic Background (check all that apply): Gender (check one):
White Male
Black or African American
Asian Female
Unknown
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
MISCELLANEOUS INFORMATION
Have you ever been employed by the College? Yes No
Position Employed from to