Fillable Adjunct App Revised August2016

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Adjunct App Revised August2016

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Human Resources
Application Process
for Adjunct / Specific Term Faculty Positions
PLEASE READ BEFORE APPLYING FOR A POSITION
Applicants interested in adjunct teaching positions should contact the department of interest directly. APPLICATIONS
WITHOUT ALL REQUIRED MATERIALS ARE INCOMPLETE AND WILL NOT BE CONSIDERED.
It is imperative that information relative to education be complete. It is a Class A Misdemeanor to misrepresent academic
credentials, Tennessee Code Annotated Sec. 49-7-133.
Applications must have an original signature and must have a current date. All application materials become the property
of TTU and will not be returned.
The university is required by federal/state employment reporting regulations to maintain a record of applicant
demographic data including gender, race, age, disability, and veteran status. The “Affirmative Action Information” form
is provided for this purpose only. Completing and returning this form is optional. All applicants are subject to a
background investigation upon being hired, promoted, or transferred.
TTU Human Resources
Derryberry Hall, Room 156
P.O. Box 5132
Cookeville, TN 38505-0001.
For information relative to job opportunities, contact Human Resources: (931) 372-3034.
A Constituent University of the Tennessee Board of Regents
http://jobs.tntech.edu
How did you find out about this job opening? (Please be specific)
_____________________________________________________
_____________________________________________________
Position applied for ____________________________________________
Department ___________________________________________________
Name ____________________________________________________________
Last First Middle Enter the last four digits only.
Current Address ____________________________________________________________________________________________________
Street City State/Zip Code
E-mail Address ______________________________________________________________
Home
Business
Telephone
Telephone
Are you a citizen of the United States? _____ If no, indicate current VISA status _____ Citizenship Country ____________________
Have you ever worked for this university? ____________ If yes, please list job title(s) and dates of employment.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Do you have the ability to perform all job-related functions of the position for which you are applying? _________________________
If no, please explain ___________________________________________________________________________________________
Because TCA 40-39-211 prohibits sex offenders required to register under TCA Title 40, Chapter 39, Part 2 from knowingly
accepting employment within one thousand feet (1,000’) of the property line of any public school, private or parochial school, licensed
day care center, other child care facility, public park, playground recreation center or public athletic field available for use by the
general public, registered sex offenders are not eligible for employment at many TBR institutions.
Are you required to register as a sex offender under TCA Title 40, Chapter 39, Part 2? Yes ___ No ____
I certify that all answers and statements herein contained and all other accompanying documentation are true to the best of my knowledge
and belief. I understand that any misstatement or concealment of material facts will subject me to disqualification before appointment or
dismissal after appointment. I consent to references and former employers being contacted regarding this application.
_________________________________________________________ ____________________________
Signature of Applicant Date
WE ARE AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER.
We comply with Titles VI and VII of the Civil Rights Act of 1964, as amended; the Equal Pay Act of 1963, as amended; the Age Discrimination in Employment Act of
1967, as amended; the Age Discrimination Act of 1975; the Pregnancy Discrimination Act; the Rehabilitation Act of 1973; the Vietnam Era Veterans’ Readjustment
Assistance Act of 1974; Title IX of the Educational Amendments of 1972; and the Americans with Disabilities Act of 1990. Tennessee Tech University is an AA/EEO
employer and does not discriminate on the basis of race, color, religion, ethnic or national origin, sex, disability, age (40 and over), status as a protected veteran, genetic
information or any other category protected by federal or state law. Inquiries regarding the nondiscrimination policies should be directed to equity@tntech.edu. Requests
for accommodation of a disability should be directed to Human Resources at 931-372-3034.
Revised 08/16
( ) -
( ) -
Application Date
Social Security Number
ADJUNCT / SPECIFIC TERM FACULTY
APPLICATION FOR EMPLOYMEN
T
Tennessee Technological University will hire only United States
citizens and aliens lawfully authorized to work in the United
States. All new employees will be required to complete an
employer’s verification form, I-9, by first day of work for pay.
✔
✔
TENNESSEE BOARD
OF
REGENTS
EQUAL
EMPLOYMENT OPPORTUNITY INFORMATION REQUEST
As
a government
contractor,
the Tennessee
Board
of
Regents
is
subject to Executive
Order
11246, as
amended; Section
402
of
the Vietnam
Era
Veterans
Readjustment
Assistance Act
of
1974;
and
Section 503
of
the Rehabilitation Act
of
1973.
ALL
of
these require government
contractors
to
take
Affirmative Action in
the employment process.
We request
your
voluntary
completion
of
the following questionnaire
to
be used
ONLY
for
the
purpose
of
monitoring the success
of
our
Affirmative Action Plan. This information will
not
be used to
discriminate
against
or
show preference for
any
application in the hiring decision.
Your
immediate attention is
requested.
GENDER:
0 Female
0 Male
BIRTH
DATE:----------
CITIZENSHIP: 0 United States Citizen 0 OTHER: (list)
__________
_
1.
Do
you consider yourself to be Hispanic, Latino
or of
Spanish Origin?*
O Yes
2.
0
No
*The term "Hispanic or Latino or Spanish Origin"
is
defined
as
a person
of
Cuban, Mexican, Puerto Rican,
South or Central American, or other Spanish culture or origin, regardless
ofrace.
In addition, select one or more
of
the
following racial categories to describe yourself:
D
D
D
White
Asian
Alaska Native
0 Black
or
African
American
0 American
Indian
D
Native Hawaiian
or
Other
Pacific
Islander
Racial Category Definitions
• White - A person having origins in any
of
the original peoples
of
Europe, the Middle East, or North Africa
• Black or African American - A person having origins
in
any
of
the Black racial groups
of
Africa
• Asian - A person having origins in any
of
the original peoples
of
the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam
• American Indian or Alaska Native - A person having origins
in
any
of
the original peoples ofNorth and
South America (including Central America), and who maintains a tribal affiliation or community
attachment
• Native Hawaiian or Other Pacific Islander - A person having origins in any
of
the original peoples
of
Hawaii, Guam, Samoa, or other Pacific Islands
Applicant Name:
________________
Date:
_________
_
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Adjunct App Revised August2016

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Completed 29 February 2020

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