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An Equal Opportunity/Affirmative Action Institution File/Applicant Number (New Mexico Institute of Mining & Technology)

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An Equal Opportunity/Affirmative Action Institution
Today’s Date: _____________________________________________
It is important that you answer every question and not leave any blank spaces.
Position you are applying for:
Name:
Present Address: City State Zip
Mailing Address: City State Zip
Telephone No. How did you learn of this position?
Will you accept temporary work? Yes No Part-time work? Yes No
Date You Can Start? Salary or Wage Expected?
Have you ever been employed here before? If Yes, when?
Are you or have you ever been a Vendor/Student at NM Tech
Names and relationship of relatives employed here:
EDUCATION
Circle the Highest Level of Education Completed, High School 9 10 11 12 College 1 2 3 4 5 6 7
Dates Attended Date of
Name and Address To From Major Course Work Degree Graduation
High School
College
College
Other
Describe any special skill or computer software training or schooling you have completed. List licenses.
TRANSCRIPTS REQUIRED FOR CONSIDERATION.
File/Applicant Number
EMPLOYMENT HISTORY
List Your Most Recent Employer First
Name of Employer Employment Dates, From: To:
Address Supervisor’s Name Tele No.
Job Title Last Wage or Salary: Full-time Part-time
Reason for leaving: May we contact this employer? Yes No
Briefly describe the work you performed:
Name of Employer Employment Dates, From: To:
Address Supervisor’s Name Tele No.
Job Title Last Wage or Salary: Full-time Part-time
Reason for leaving: May we contact this employer? Yes No
Briefly describe the work you performed:
Name of Employer Employment Dates, From: To:
Address Supervisor’s Name Tele No.
Job Title Last Wage or Salary: Full-time Part-time
Reason for leaving: May we contact this employer? Yes No
Briefly describe the work you performed:
Name of Employer Employment Dates, From: To:
Address Supervisor’s Name Tele No.
Job Title Last Wage or Salary: Full-time Part-time
Reason for leaving: May we contact this employer? Yes No
Briefly describe the work you performed:
Attach additional sheets for a complete employment history.
Employment Application.doc
07/19
REFERENCES
List Three Persons Who Have Knowledge of Your Abilities and Qualifications (not relatives)
Name and Address Years Known Telephone No.
I certify that the information contained in this application is correct to the best of my knowledge and I understand that any misrepresentation is grounds for dismissal from employment or for rejecting my application for employment.
I authorize New Mexico Tech to conduct an inquiry into any job-related information contained in this application. I hereby authorize al
l current (unless indicated otherwise on this application) and previous employers to release any
information in their files pertaining to my employment history, including, but not limited to, the nature of my employment, wages, attendance records, performance reviews and disciplinary actions.
Positions employed at EMRTC, Campus Police, the Post Office and positions that operate construction equipment or that have access to I
nstitute cash or have check signing authority are subject to a pre-employment drug screen.
An offer of employment for any of these positions is conditional on successfully passing the pre-employment drug screen.
_______________________________________________________________ _________________________________________
Signature of Applicant Date
A separate application must be submitted for each position you apply for. This application will not be considered for other vaca
nt
positions.
Pre-employment Offer to Self-Identify
Have you ever been employed by New Mexico Tech? ____yes ____no
How do you describe yourself? (check one)
_____White (Not of Hispanic Origin): Persons having origins in any of the original peoples of
Europe, North Africa or the Middle East.
_____Black (Not of Hispanic Origin): Persons having origins in any of the Black racial groups.
_____Hispanic: Persons of Mexican, Puerto Rican, Cuban, Central or South American or any
other Spanish Culture origins.
_____Asian or Pacific Islander: Persons having origins in any of the original peoples of the Far
East, Southeast Asia, the Indian Subcontinent, or Pacific Islands. This area includes for example,
China, Japan, Korea, the Philippine Islands, and Samoa.
_____American Indian or Alaskan Native: Persons having origins in any of the original peoples
of North America, and who maintain cultural identification through tribal affiliation or
community recognition.
Gender _____Female _____Male
Are you a Disabled Veteran of the United States Military? _____yes _____no
Are you a protected Veteran protected by VEVRAA? _____yes _____no
Are you an active duty wartime or campaign badge Veteran? _____yes _____no
New Mexico Institute of Mining & Technology, as a standing policy, does not discriminate
against individuals because of their race, color, religion, creed, age, sex, national origin, physical
or mental handicap, disability, or status as a qualified protected veteran. Any discriminatory
action can be a cause for disciplinary action. This policy applies to all Institute programs and
facilities including, but not limited to admissions, educational programs, and employment. This
contractor and subcontractor shall abide by the requirements of 41 CFR 60-300.5 (a). This
regulation prohibits discrimination against qualified protected veterans, and requires affirmative
action by covered prime contractors and subcontractors to employ and advance in employment
qualified protected veterans. Discrimination is prohibited by Titles VI and VII of the Civil Rights
Act of 1964, Title IX of the Educational Amendments of 1972, sections 503 and 504 of the
Rehabilitation Act of 1973, age Discrimination in Employment Act Amendments of 1978,
Americans with Disabilities Act, New Mexico Human Rights Act, and other federal and state
regulations. Coordination of the compliance efforts of New Mexico Institute of Mining &
Technology with respect to these laws and regulations is under the direction of the Director of
Affirmative Action and Compliance Programs, 801 Leroy Place, Socorro, New Mexico 87801.
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An Equal OpportunityAffirmative Action Institution FileApplicant Number (New Mexico Institute of Mining & Technology)

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Completed 31 August 2021

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