Fillable APPLICATION FOR EMPLOYMENT (Northwest State Community College)

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APPLICATION FOR EMPLOYMENT (Northwest State Community College)

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File type: PDF

U.S.A. forms for Northwest State Community College

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22600 State Route 34
Archbold, OH 43502
APPLICATION FOR EMPLOYMENT
Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin,
handicap or veteran status.
IDENTIFICATION
Application Date: _________________________
Name:
________________________
(Last)
______________________________
(First)
____
(M.I.)
Address:
______________________
(Street)
___________
(State)
___________
(Zip)
Telephone:
____________________
(Day)
___________________
(Evening)
_______________________________________
(Email)
Position Desired: _______________________________
Are you able to provide documentation of
legal authorization to work in the United
States?
☐ Yes ☐ No
How did you hear about this position? ☐ NSCC Website ☐ Indeed ☐ Ohio Means
Jobs ☐ Classified Ad ☐ Other
If other: _______________________________________________
AVAILABILITY – Desired schedule (please check all that apply):
If seeking part-time employment, what number of
hours per week can you work?
___________
☐ Full-time; year-round
☐ Part-time; year-round
☐ Full-time; 9-10 months/year
☐ Part-time; 9-10 months/year
EDUCATION RECORD – Please indicate highest completed in each category:
High School
Diploma or GED?
☐ Yes ☐ No
College
1 ☐ 2 ☐ 3 ☐ 4 ☐
Graduate School
1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐
HIGHSCHOOL
Name:
Address:
COLLEGE
Major
Credits Earned or Degree Conferred
Name:
Address:
Name:
Address:
Name:
Address:
BUSINESS, TRADE, or VOCATIONAL SCHOOL
License or Certificate
Name:
Address:
Name:
Address:
EMPLOYMENT HISTORY – Please provide information for all employment within the past 10 years, starting with the most recent
employer. Do not substitute a resume for this section. You may attach additional pages if necessary.
Dates of
Employment
Employer:
Job Title:
From
____________
To
____________
☐ Full-time
☐ Part-time
Address:
Supervisor:
Phone:
Final Salary:
Reason for Leaving:
Major Duties:
Dates of
Employment
Employer:
Job Title:
From
____________
To
____________
☐ Full-time
Part-time☐
Address:
Supervisor:
Phone:
Final Salary:
Reason for Leaving:
Major Duties:
Dates of
Employment
Employer:
Job Title:
From
____________
To
____________
☐ Full-time
☐ Part-time
Address:
Supervisor:
Phone:
Final Salary:
Reason for Leaving:
Major Duties:
Dates of
Employment
Employer:
Job Title:
From
____________
To
____________
☐Full-time
☐Part-time
Address:
Supervisor:
Phone:
Final Salary:
Reason for Leaving:
Major Duties:
SUPPLEMENTAL INFORMATION – Use this section to show evidence of meeting the qualifications for the position or providing
information you would like to add for consideration.
General Job-Relevant Information:
Computer Hardware and/or Software; Other Tools and Equipment:
If you are applying for a position that requires a standard driver’s license or a commercial driver’s license to perform the essential
duties of the job, please answer the following:
Do you currently have a valid standard Ohio driver’s license?
☐ Yes
☐ No
Do you currently have a valid Ohio commercial driver’s license?
☐ Yes
☐ No
Do you currently or have you had, in the last five (5) years, a driver’s license from
another state?
State: ______________________
☐ Yes
☐ No
Has your driver’s license been suspended or revoked within the last five (5) years?
☐ Yes
☐ No
Have you had any traffic violation or accidents in the past five (5) years?
☐ Yes
☐ No
Have you previously been employed by Northwest State?
☐ Yes
☐ No
If yes, please list:
Position: _____________________________________
Department: __________________________________
Dates: _______________________________________
REFERENCE – List three professional/work references from positions held within the last ten years.
Name:
Company:
Title/Position:
Address:
Affiliation (Work Relationship):
Phone:
No. of Years Known:
Email Address:
May we contact? ☐ Yes ☐ No
Name:
Company:
Title/Position:
Address:
Affiliation (Work Relationship):
Phone:
No. of Years Known:
Email Address:
May we contact? ☐ Yes ☐ No
Name:
Company:
Title/Position:
Address:
Affiliation (Work Relationship):
Phone:
No. of Years Known:
Email Address:
May we contact? ☐ Yes ☐ No
The following statement is a part of the application. Read carefully before signing.
I certify that the answers I have made to all of the questions in this application are true and complete to the best of my knowledge. I
understand that any material omission, misrepresentation or falsification of this information is sufficient cause for rejection of my
application or termination of my employment.
I understand that Northwest State community College operates under the “At-Will” doctrine. Employer or employee may terminate
employment at any time for any reason not prohibited by law.
I understand that any offer of employment is conditional upon proof of legal authorization to work in the United States as required by the
Immigration Reform and Control Act.
I hereby authorize representatives of Northwest State Community College to obtain background information about me including but not
limited to verification of education, investigation of present and past employment, and review of criminal convictions. I release
Northwest State Community College and its representatives from liability for seeking such information and all sources for furnishing
such information.
☐ By checking the box at the left, I certify that I have read and agree with the above statements.
Applicant Signature ______________________________________________ Date ________________________
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APPLICATION FOR EMPLOYMENT (Northwest State Community College)

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Completed 3 October 2020

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