APPLICATION FOR FACULTY OR EXECUTIVE POSITIONS
The University of Hawai‘i is an equal opportunity/affirmative action institution and is committed
to a policy of nondiscrimination on the basis of race, sex, gender identity and expression, age,
religion, color, national origin, ancestry, disability, marital status, arrest/court record (except as
permitted by State law), sexual orientation, status as a covered veteran or other grounds protected
under applicable state and federal laws, regulations, and/or executive orders. It is the policy of
the University of Hawaii to provide equal opportunity in higher education, both in the
educational mission and as an employer. All qualified persons, especially women, members of
minority groups, persons with disabilities and Vietnam Era veterans, are encouraged to apply.
(This application form must be submitted directly to the college to which you are
applying. If applying to more than one college, submit separate applications to
each.)
ISLAND OF OAHU:
HONOLULU COMMUNITY COLLEGE WINDWARD COMMUNITY COLLEGE
874 Dillingham Boulevard 45-720 Kea‘alaha Road
Honolulu, HI 96817 Kāne‘ohe, HI 96744
KAPI‘OLANI COMMUNITY COLLEGE LEEWARD COMMUNITY COLLEGE
4303 Diamond Head Road 96-045 Ala ‘Ike
Honolulu, HI 96816 Pearl City, HI 96782
NEIGHBOR ISLANDS:
HAWAI‘I COMMUNITY COLLEGE KAUA‘I COMMUNITY COLLEGE
200 West Kawili St. 3-1901 Kaumuali‘i Highway
Hilo, HI 96720-4091 Līhu‘e, HI 96766
UNIVERSITY OF HAWAI‘I MAUI COLLEGE
310 Ka‘ahumanu Avenue
Kahului, HI 96732
APPLICATION FOR FACULTY OR EXECUTIVE POSITIONS
College:
Title of Position Applying For (or Subjects) Position No.
Name:
Last First M.I.
Current Mailing Address:
Street Apt. No. City State Zip Code
Telephone Number: Home ( ) Business ( )
Email Address:
Cellular Phone No. ( )
At which number may we contact you? ( )
Fax No: ( )
What are the best hours to contact you?
FOR OFFICE USE ONLY
Date Application Received: Interviewed:
Transcript Received: Copy: Official:
File Received: Recommended:
Letters of Recommendation Received: 1. 2. 3.
COMMENTS:
RECOMMENDED RANK AND STEP PLACEMENT:
-3-
I. EDUCATION AND TRAINING
A. Academic: Beginning with your present or most recent educational experience, list all
schools you attended beyond Grade 12:
School Name and Address
Major Field of Study/Minor
Type of Degree
Received
Date Received
(month/year)
B. Training: Beginning with your most recent training experience, list all military (if
appropriate), trade, technical, apprenticeship, or special training you have received.
School Name and Address
Occupational Area
Completed
Program?
Yes/No
Date
-4-
II. OCCUPATIONAL EXPERIENCE HISTORY
A. Teaching Experience
Beginning with your present or most recent teaching experience, list your teaching
experience. If additional space is required, continue on a separate sheet and attach.
Position Title
FT/PT %
Date
(Mo/Yr to Mo/Yr)
Number of Credits Taught
(semester/quarter)
List Post-Secondary Courses Taught (attach additional pages)
Post-Secondary Courses Taught
Date
(Mo/Yr to Mo/Yr)
Number of Credits Taught
-5-
B. Other Professional Experience
Beginning with your present or most recent job, experience, other than teaching, provide the
information below. If additional space is required, continue on a separate sheet and attach.
Employer
Address
Supervisor's Name/Title
Your Title
Full-Time From________ to ________ Hrs/Week _______
(Mo/Yr) (Mo/Yr)
Part-Time From________ to ________ Hrs/Week _______
(Mo/Yr) (Mo/Yr)
Beginning Salary: $
Ending Salary: $
Reason(s) for Leaving:
Description of Duties and Responsibilities:
Employer
Address
Supervisor's Name/Title
Your Title
Full-Time From________ to ________ Hrs/Week _______
(Mo/Yr) (Mo/Yr)
Part-Time From________ to ________ Hrs/Week _______
(Mo/Yr) (Mo/Yr)
Beginning Salary: $
Ending Salary: $
Reason(s) for Leaving:
Description of Duties and Responsibilities:
-6-
Employer
Address
Supervisor's Name/Title
Your Title
Full-Time From________ to ________ Hrs/Week _______
(Mo/Yr) (Mo/Yr)
Part-Time From________ to ________ Hrs/Week _______
(Mo/Yr) (Mo/Yr)
Beginning Salary: $
Ending Salary: $
Reason(s) for Leaving:
Description of Duties and Responsibilities:
Employer
Address
Supervisor's Name/Title
Your Title
Full-Time From________ to ________ Hrs/Week _______
(Mo/Yr) (Mo/Yr)
Part-Time From________ to ________ Hrs/Week _______
(Mo/Yr) (Mo/Yr)
Beginning Salary: $
Ending Salary: $
Reason(s) for Leaving:
Description of Duties and Responsibilities:
-7-
III. PUBLICATIONS, RESEARCH AND OTHER CREATIVE ACTIVITIES
Title
Co-Authors
Title of Journals of Other
Publications and Date
Publisher and Date
(Books Only)
IV. PERTINENT SPECIAL QUALIFICATIONS
List, as appropriate, membership in professional or scientific societies, community service,
activities, honors, awards, fellowships, etc. Also include Technical/Vocational
certification/license and expiration date:
-8-
V. CURRENT REFERENCES
List below the names and addresses of those who will send letter of reference and/or who may be
contacted regarding your application:
Name in Full
Position
Email or Mailing Address
Telephone
Number
APPLICANTS MAY SUBMIT OTHER MATERIALS (papers, writings, statements, etc.) WHICH MAY
BE OF ASSISTANCE IN EVALUATING THEIR QUALIFICATIONS.
ALL REQUESTED DOCUMENTS AND INFORMATION BECOME THE PROPERTY OF THE
RESPECTIVE COLLEGE. FAILURE TO SUBMIT ALL REQUIRED DOCUMENTS SHALL DEEM
AN APPLICATION INCOMPLETE AND WILL NOT BE CONSIDERED.
VI. CLERY ACT
In accordance with the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime
Statistics Act, annual campus crime statistics for the University of Hawai‘i may be viewed at:
http://ope.ed.gov/security/ or a paper copy may be obtained upon request from the respective UH
Campus Security or Administrative Services Office.
-9-
VII. CERTIFICATION OF APPLICANT AND RELEASE OF EMPLOYMENT INFORMATION
Please Read Carefully Before Signing
A. I hereby certify that the information contained in this application is true, correct, and
complete. I agree and understand that any false or misleading statements or omissions made in
this application or interview(s) are grounds for disqualification from further consideration or for
dismissal from employment, regardless of when and how discovered. Additionally, information
that cannot be officially verified may be a basis for not hiring me for employment with the
University of Hawaii.
B. I understand that failure to provide requested application information on a timely basis may
deem my application to be incomplete.
C. I understand that, if selected, I must present documentary evidence to verify my employment
eligibility, pursuant to the Immigration Reform and Control Act of 1986.
D. I understand and agree that the University of Hawai‘i may make a full and complete
investigation of my personal or employment history, and authorize any current or former
employer, person, firm, corporation, school, government agency, or other entity to provide the
University of Hawai‘i with any information (including fact or opinion) they may have regarding
me. In consideration of the University of Hawaii’s review of this application, I release the
University of Hawai‘i and all providers of any information from any liability which may arise as
a result of furnishing and receiving this information. I understand and agree that any
employment offer or continued employment shall be conditional on the receipt of satisfactory
references as determined by the University of Hawai‘i. If employed by the University of
Hawai‘i, I further authorize the University of Hawai‘i to provide truthful information (including
fact or opinion) regarding my employment to any potential or future employer.
E. I agree that the University of Hawai‘i as permitted by state law, may inquire into and
consider any criminal conviction record that I may have. This includes, but is not limited to, the
University of Hawai‘i considering any criminal conviction record that I may have after it makes
a conditional offer of employment. The University may withdraw a conditional employment
offer if I have a criminal conviction record which bears a rational relationship to the duties and
responsibilities of the position for which I am applying. Any criminal conviction record that is
more than 10 years old (excluding periods of incarceration) or that involves certain Family Court
matters will not be considered, except as permitted by law.
F. If hired, I agree not to disclose or use confidential information belonging to prior employers
and that I will inform the University of Hawai‘i of any agreements that would limit my ability to
work for the University of Hawai‘i.
Photocopies of this authorization for the release of information shall have the same power and
effect as an original.
AUTHORIZATION SIGNATURE OF APPLICANT:__________________________________
Date:
An Equal Opportunity/Affirmative Action Institution
CC Personnel Form 27A (Revised 01/2012)