I hereby authorize Missouri State University to contact additional individuals with respect to this
application, except the following people who should NOT be contacted unless I become a finalist:
1. _______________________________________ 1. ________________________________________
2. _______________________________________ 2. ________________________________________
ADDITIONAL INFORMATION (Please provide any additional information that you consider
important to your employment as a Graduate Assistant).
Signature Date _______
Missouri State University is a community of people with respect for diversity. The University emphasizes the dignity and equality common to all persons and adheres to a strict nondiscrimination
policy regarding the treatment of individual faculty, staff, and students. In accord with federal law and applicable Missouri statutes, the University does not discriminate on the basis of race,
color, religion, sex, national origin, ancestry, age, disability, or veteran status in employment or in any program or activity offered or sponsored by the University. In addition, the University does
not discriminate on any basis not related to the applicable educational requirements for students or the applicable job requirements for employees.
The University maintains a grievance procedure incorporating due process available to any person who believes he or she has been discriminated against. Missouri State University is an Equal
Opportunity/Affirmative Action employer. Inquiries concerning he grievance procedure, Affirmative Action Plan, or compliance with federal and state laws and guidelines should be
addressed to Equal Opportunity Officer, Park Central Office Bldg. 111, 901 South National Ave., Springfield, MO, 65897, (417)836-3257.
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