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An Equal Opportunity/Affirmative Action Employer (Rocky Mountain College)

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  • 44 check-boxes
  • 133 other fields

Country of origin: US
File type: PDF

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An Equal Opportunity/Affirmative Action Employer
Please type or print clearly in blue or black ink.
Full Name (Last) (First) (MI) Date
GENERAL INFORMATION
Home Address
City State Zip
Email Address
Position Desired
Salary desired for this position $
If employed in this position, would you be in a supervisory
relationship to any relative or member of your household?
Yes No If yes, how?
Telephone Number
Cell Phone Number
Are you legally eligible to work in the U.S.
(Verification will be required) If yes, and you are NOT
currently a US Citizen please list your dates of eligibility:
from to
If yes, dates of employment _____________________________
If yes, explain with date, location, and offense. A “yes” does not
disqualify you from employment; all circumstances will be considered.
How did you learn about this position? Please explain where applicable.
Newspaper Advertisement
Announcement Flyer
Professional Journal
The Chronicle of Higher Education
Invited to apply by:
Other
PLEASE READ THE FOLLOWING BEFORE FILLING OUT THIS FORM.
Affirmative Action and Equal Employment Opportunity have been and will continue to be fundamental principles at
Rocky Mountain College where employment is based upon personal capabilities and qualifications without discrimination
because of race, color, religion, sex, sexual orientation, age, national origin, disability, marital status, or any other
protected characteristics as established by law. No question on this application is intended to secure information to be used
for such discrimination.
This application will be given every consideration, but its receipt does not imply that the applicant will be employed.
This application will be considered only for the position for which you are applying. If you are not offered employment
and still wish to be considered for employment with Rocky Mountain College, it will be necessary or you to reapply when a
position becomes available for which you are qualified.
Please print and complete all questions. This application will not be considered if questions are left unanswered, or it is
not signed and dated. Attach additional paper if allotted space is not sufficient.
EMPLOYMENT APPLICATION–STAFF
Please list the last five positions held, starting with the most current position. If more space is needed, please attach additional paper to the application form.
DO NOT WRITE “SEE RESUME.” IF YOU HAVE A RESUME, PLEASE ATTACH IT IN ADDITION TO COMPLETING THIS SECTION.
From: Mo/Yr
To: Mo/Yr
Employer
Current/Last Rate of Pay:
Reason for leaving:
From: Mo/Yr
To: Mo/Yr
Employer
Current/Last Rate of Pay:
Reason for leaving:
From: Mo/Yr
To: Mo/Yr
Employer
Current/Last Rate of Pay:
Reason for leaving:
From: Mo/Yr
To: Mo/Yr
Employer
Current/Last Rate of Pay:
Reason for leaving:
From: Mo/Yr
To: Mo/Yr
Employer
Current/Last Rate of Pay:
Reason for leaving:
If there are any periods unaccounted for, please explain.
High School (name):
City, State:
Highest Grade Completed: (circle one)
9 10 11 12
Undergraduate school:
College or University (name):
City, State:
Major:
# Years Completed:
Graduate school:
College or University (name):
City, State:
Major:
# Years Completed:
EMPLOYMENT
EDUCATION
Give the names of three (3) personal references who are not relatives or previous employers.
Name Address, City, State, Zip Occupation Phone/Cell Number
Indicate any experience and/or training you have received that relates to the position for which you are applying in the appropriate
space.
Administrative Skills
Maintenance Skills
Number of years experience:
Typing (wpm )
Word Processing (application)
Spreadsheet (application)
Database (application)
Other (application)
Calculator
Accounting/Bookkeeping/Payroll
Other (specify)
Number of years experience:
Welding
Painting/Carpenter
Plumbing
Power Tools (specify)
Blue Print Reading
Lawn Equipment
Custodial
Telephone Systems
Other (specify)
Describe other special skills or experience that you have not noted in other parts of this application, but feel would help you in this
position. Examples include: military service, volunteer programs, etc.
Please list any special certifications, licenses, etc. that you possess that relate to this position.
PERSONAL REFERENCES
SKILLS
APPLICANT CERTIFICATION
READ CAREFULLY BEFORE SIGNING
I certify that the information in this application is true and complete. Any false statements, concealment or omissions are
grounds for refusal to hire or immediate dismissal if hired.
I authorize schools, former employers, former supervisors and co-workers to provide any and all information pertinent to my being
considered for employment and hereby release those providing such information from any liability for doing so.
I understand that employment, if offered, is contingent upon my providing additional information for employee record purposes and
also upon my providing proof of identity and employment eligibility and completing a Form I-9. I understand that if I am hired, the
length of my employment is not guaranteed. Recognizing that I will be free to voluntarily terminate my employment at any time, with
or without cause, I acknowledge that my employment can be modified or terminated with or without cause and with or without notice
during the probationary period, and at any time for cause and that, if employed, employment does not constitute a contract of
employment between myself and the College. I understand that no manager or representative of the College, other than the President,
has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to
the foregoing, either prior to employment or after I have become employed. I will abide by and conform to all College policies, rules,
and procedures as may be in effect from time to time.
I acknowledge that I have read the above, understand its content and meaning, and agree to all of its provisions.
_____________________________________________ __________________
Applicant’s Signature Date
Rocky Mountain College
Human Resources Office
1511 Poly Drive
Billings, Montana 59102
Toll Free: 1.800.877.6259
Phone: 406.657.1160
Fax: 406.238.7262
Email:
jobs@rocky.edu
www.rocky.edu
Rev. 10/11
click to sign
signature
click to edit
NAME: _________________________________ PHONE : _____________________________ DATE: ________________________________
As an Equal Opportunity Employer, Rocky Mountain College is required to report the composition of its work force to state and federal governments. The information on this form will be
filed separately and will not be used to make a decision about your employment. It will be available only to the person responsible for government reporting or for affirmative action
reasons and safeguards will be used to prevent the discriminatory abuse of this information. Your voluntary cooperation is appreciated.
GENERAL INFORMATION: (Please enter the requested information and/or check the box beside the appropriate designation)
Birth Date: (mm/dd/yr) __________/_________/________ Gender: (Please check the box) Male Female
ETHNIC BACKGROUND:
(Please check the box beside the ethnic group with which you most identify in custom and communication)
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or
origin regardless of race.
White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North America.
Black or African American: A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander:A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian: A person having origins in any of the original peoples of the far East, Southeast Asia, or the
Indian Subcontinent, including 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 of North and South America, including
Central America, and who maintain tribal affiliation or community attachment.
Two or more Races: All persons who identify with more than one of the above five races.
IMMIGRATION STATUS:
(Please check if applicable)
Nonresident Alien A person who is not a citizen or national of the United States and who is in this country on a visa or temporary
basis and does not have the right to remain permanently.
VETERAN STATUS:
(Please check if applicable)
Vietnam Era (August 5, 1964 – May 7, 1976) Other than Vietnam Status Spouse of deceased veteran
Disabled Vietnam Veteran Disabled veteran (other than Vietnam)
Dates of Service: From: _________ To: ____________
Total Active Service Time: Years: _______ Months:_______ Days: _______
DISABLED STATUS: (Please check yes or no for each area)
YES NO Do you have physical, sensory or medical impairment which substantially limits one or more life activities (e.g. walking, seeing, hearing, breathing, learning)?
YES NO Do you have a physical, mental or other health condition that has lasted for six months or more and which limits the kind of or amount of work you can do at a job?
I prefer not to complete this form.
VOLUNTARY and CONFIDENTIAL EQUAL EMPLOYMENT
OPPORTUNITY (EEO) QUESTIONNAIRE
(This information is for record-keeping and for Federal & State reporting purposes only.)
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An Equal OpportunityAffirmative Action Employer (Rocky Mountain College)

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Completed 25 August 2020

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