KIRTLAND COMMUNITY COLLEGE
10775 North St. Helen Road
Roscommon, MI 48653
Fax: 989-275-8210
Email: hr@kirtland.edu
APPLICATION FOR FACULTY POSITION
PERSONAL INFORMATION
Last Name: First: Middle:
Date
Street Address
Home Phone Number
( )
City, State, Zip Code
Business Phone Number
( )
Have you ever applied for employment at Kirtland? Yes No
Email:
Position Desired
When can you begin work?
Are you available for full-time employment? Yes No
Are you available for part-time employment? Yes No
Are you authorized to work in the US?
Yes No
EDUCATION
SCHOOL NAME AND LOCATION
COURSE OF STUDY
YEARS
COMPLETED
DID YOU
GRADUATE?
Undergraduate
College
Yes
No
Graduate
School
Yes
No
Graduate
School
Yes
No
HONORS AND AWARDS
Reset Form
OCCUPATIONAL HISTORY
List all non-teaching positions held in reverse chronological order.
Vocational-Technical applicants should attach complete resume of occupational history.
ORGANIZATION
LOCATION
POSITION OR
TITLE
NUMBER OF
YEARS
DATES OF
EMPLOYMENT
TEACHING/EDUCATIONAL ADMINISTRATIVE HISTORY
List all teaching and educational administrative positions in reverse chronological order
SCHOOL OR
COLLEGE
LOCATION
POSITION
SUBJECT TAUGHT
LEVEL OF
INSTRUCTION
NUMBER
OF YEARS
DATES
MEMBERSHIP IN JOB-RELATED PROFESSIONAL ORGANIZATIONS
ORGANIZATION
YEARS
ORGANIZATION
YEARS
MILITARY
Did you serve in the US Armed Forces? Yes No
If yes, in what branch?
Describe any training received relevant to the position for which you are applying:
APPLICANTS FOR VOCATIONAL-TECHNICAL POSITIONS ONLY
Are you eligible to hold a state vocational certificate?
Yes No
Applicants for nursing or cosmetology positions,
please indicate license number
REFERENCES
List a minimum of four references that may be contacted regarding your character and ability as an educator
Name
Phone Number
Business/Profession and Title
Name
Phone Number
Business/Profession and Title
Name
Phone Number
Business/Profession and Title
Name
Phone Number
Business/Profession and Title
ADDITIONAL REFERENCES
Vocational-Technical applicants should list references who may be contacted regarding work experience
Name
Phone Number
Business/Profession and Title
Name
Phone Number
Business/Profession and Title
Name
Phone Number
Business/Profession and Title
Name
Phone Number
Business/Profession and Title
May we contact your present employer? Yes No
TRANSCRIPTS AND CREDENTIALS: This application is not considered complete until transcripts and credentials (your professional
biography) are on file at the college. Interviews will normally be arranged only after the application is complete.
APPLICANT SIGNATURE
The information provided in this application for employment is true, correct and complete. If employed, any misstatement or
omission of fact on this application may result in my immediate dismissal. I understand that acceptance of an offer of employment
does not create a contractual obligation upon the employer to continue to employ me in the future.
Date Signature
KIRTLAND COMMUNITY COLLEGE IS AN EQUAL OPPORTUNITY EMPLOYER
The college’s annual security report is available upon request.
For a copy, contact 989-275-5000, ext. 283
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