APPLICATION FOR EMPLOYMENT
Wilson Community College is an equal opportunity employer.
INSTRUCTIONS
In order to be processed, the application must be completed in ink (or typed) and signed. Please answer all questions and complete all
sections of this form, “see resume” is not acceptable. Resumes will not be accepted in lieu of completing an application form.
CURRENT INFORMATION
Position Sought
(You must complete a separate application for each position)
Name Date
Mailing Address
Street & Number, RFD, or P.O. Box
City State Zip
Home Phone Business Phone Cell Phone
Email When would you be available for employment?
GENERAL INFORMATION
A. Have you previously been employed with Wilson Community College?
q Yes q No
If yes, what department and when?:
B. Are you a retiree of the State of North Carolina?
q Yes q No
C. Will you accept employment requiring regular night or weekend work?
q Yes q No
D. Will you accept employment requiring occasional night or weekend work?
q Yes q No
E. Are you related by blood or marriage to any employee of the College?
q Yes q No
If yes, give name and relationship:
F. Are you legally eligible for employment in the United States?
(Proof of citizenship or immigration status REQUIRED upon employment.)
q Yes q No
G. Can you perform the essential functions of the position as described on the position announcement
for which you have applied?
q Yes q No
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EMPLOYMENT HISTORY (Provide your complete employment history)
A. CURRENT OR MOST RECENT EMPLOYMENT
Employer Address
Job Title Supervisors Name & Title
Phone Date Employed Date Separated
Full Time: Years Months Part Time: Years Months If part-time, number of hours worked per week:
Starting Salary Ending Salary Number Taught Number Supervised
Duties
Reason for leaving
May we inquire of this employer about your qualifications and character?
q Yes q No
B. NEXT EMPLOYMENT
Employer Address
Job Title Supervisors Name & Title
Phone Date Employed Date Separated
Full Time: Years Months Part Time: Years Months If part-time, number of hours worked per week:
Starting Salary Ending Salary Number Taught Number Supervised
Duties
Reason for leaving
May we inquire of this employer about your qualifications and character?
q Yes q No
C. NEXT EMPLOYMENT
Employer
Address
Job Title Supervisors Name & Title
Phone
Date Employed Date Separated
Full Time: Years Months Part Time: Years Months
If part-time, number of hours worked per week:
Starting Salary Ending Salary
Number Taught Number Supervised
Duties
Reason for leaving
May we inquire of this employer about your qualifications and character?
q Yes q No
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EMPLOYMENT HISTORY (Continued)
D. NEXT EMPLOYMENT
Employer Address
Job Title Supervisors Name & Title
Phone Date Employed Date Separated
Full Time: Years Months Part Time: Years Months If part-time, number of hours worked per week:
Starting Salary Ending Salary Number Taught Number Supervised
Duties
Reason for leaving
May we inquire of this employer about your qualifications and character?
q Yes q No
E. NEXT EMPLOYMENT
Employer Address
Job Title Supervisors Name & Title
Phone Date Employed Date Separated
Full Time: Years Months Part Time: Years Months If part-time, number of hours worked per week:
Starting Salary Ending Salary Number Taught Number Supervised
Duties
Reason for leaving
May we inquire of this employer about your qualifications and character?
q Yes q No
(Attach additional pages if this does not include your complete employment history)
EDUCATION AND TRAINING
Education Name and Location
Date Attended
(Month/ Year)
Degree/
Diploma
Year Received Major
High School
Diploma/GED
Associate
Degree
Bachelors
Degree
Master’s
Degree
Doctoral
Degree
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OTHER QUALIFICATIONS
List subjects you feel qualified to teach; related volunteer experience; any skills, abilities, special certifications, licenses, or special training you
have had and feel are applicable to the position for which you have applied. Include skills with equipment or machines you can operate. If you
are applying for a CLERICAL position, please indicate speeds for typing.
PLEASE INCLUDE
PROFESSIONAL STATEMENT: If you are applying for a teaching position, on a separate page(s) indicate why you chose teaching as a
profession, your philosophy of education, and your views on academic standards.
TRANSCRIPT: A non-returnable copy of college credits IS REQUIRED to process your application, otherwise your application will be deemed
incomplete and will not be considered. Oicial transcripts WILL BE REQUIRED if you are hired for a position and must be received in the
Human Resources Oice within thirty (30) days of oer of employment.
REFERENCES
List two references who have knowledge of your qualifications for the position for which you are applying. Do not repeat the names of
supervisors listed with your employment record unless they can no longer be contacted at those addresses. Please list the appropriate day-
time number. DO NOT LIST RELATIVES.
A. Name Daytime Phone
B. Name Daytime Phone
CERTIFICATIONS - Read carefully before signing and dating.
I certify that all information on this application is correct. I authorize any agent or employee of the College to verify this information. Such
reference calls may include persons other than those I have listed as references in my application materials. I will hold neither the inquiring
party/organization nor the responding party/organization liable for information exchanged regarding the execution of my former employment.
I understand that any information released by my prior employers will be held in strictest confidence, that it will be viewed only by those
involved in the hiring decision, and that I waive any rights to see this information.
I certify that, to the best of my knowledge, the information given truly represents my background and experiences. I understand that if I have
knowingly misrepresented or falsified any of this application information I may be disqualified from employment consideration or dismissed
from employment with Wilson Community College.
I understand that employment may be contingent upon a satisfactory background investigation of any or all of the following records: criminal,
motor vehicle, credit, reference checks, and/or drug test.
Signature Date
NOTE: Wilson Community College is committed to providing a reasonably safe environment for students, employees and visitors and to complying with the Clery Act. Therefore, interested
prospective employees may view the annual campus security report at: www.wilsoncc.edu/security/campus-crime-report or may request a paper copy from the Human Resources Oice.
Wilson Community College is an equal opportunity employer and, as such, we provide employment opportunities without regard to race, color, religion, national origin, sex (including pregnancy),
age, disability, veteran or military status, genetic information or other legally protected characteristics.
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click to sign
signature
click to edit
PERSONAL INFORMATION FORM
The sole purpose of the Personal Information Form is to comply with record-keeping, reporting, and other legal requirements. Periodic reports
to governmental agencies may be made on the following information. The completion of the Personal Information Form is optional. If you
choose to volunteer the requested information, please note that all Personal Information Forms are kept in a confidential file and are not a part
of your application for employment. Please note: INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.
Position Sought
Name
Gender: q Male q Female
Citizenship: q Lawful permanent resident q Non-resident alien q U.S. Citizen
Ethnicity: q Hispanic/Latino q Not Hispanic/Latino
Race: (check one or more) q American Indian or Alaska Native q Asian q Black or African American
q Native Hawaiian or other Pacific Islander q White q Other:
VETERAN STATUS
US Armed Forces Veteran: q Yes q No Spouse or Dependent of Veteran: q Yes q No
Branch of Service Dates of Service
If served during war or conflict, please specify:
(Example: Vietnam, etc.)
NOTE: Copy of DD Form 214 must be attached as proof to right of veterans preference.
If required, have you registered with the Selective Service (Military Draft Board)?
q Yes q No
How did you find out about this position? (If newspaper, which one?)
To help us learn about your experiences, abilities, interests, and education please prepare this application thoroughly and accurately.
Your “Application for Employment” is used as a part of the selection process and should represent your best eort. It can only be
oicially considered after you have completed, signed, and submitted the application to Wilson Community College’s Human
Resources Department.
PO Box 4305 • 902 Herring Avenue
Wilson, NC 27893
(252) 291-1195 • wilsoncc.edu
Equal Opportunity Employer
Revised 03/2019
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