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Application (Butler County Community College)

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BROWSE BUTLER COUNTY COMMUNITY COLLEGE FORMS

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HR 11/3/2017
HUMAN RESOURCES
107 COLLEGE DRIVE
BUTLER, PA 16002
PHONE: 724-287-8711 EXT. 8353
ADMINISTRATION, FACULTY, STAFF
EMPLOYMENT APPLICATION
PLEASE READ CAREFULLY
APPLICANTS MAY REQUEST ANY NEEDED ACCOMMODATION TO PARTICIPATE IN THE APPLICATION PROCESS.
NONDISCRIMINATION POLICY
Butler County Community College is committed to providing equal opportunity in admissions and treatment of students, in educational programs for
students, in employment opportunities and in governance of the College, without regard to race, color, religious creed, ancestry, national origin,
handicap or disability, age, sex, sexual orientation, gender identity or expression, genetic information, veteran status, marital status, family status,
or other classification protected by applicable law.
The Col
lege shall take affirmative action to ensure (1) that it does not discriminate against an employee or applicant for employment or another
person because of race, color, religious creed, ancestry, national origin, handicap or disability, age, sex, sexual orientation, or gender identity or
expression, genetic information, veteran status, marital status, family status, or other classification protected by applicable law; (2) that it does not
subject students to unlawful discrimination in the admission process, take any action, direct or indirect, to segregate students in a classroom or
course, or subject students to different or separate treatment in, nor restrict the enjoyment by a student of, a service, facility, activity or program at
the College on the basis of race, color, religious creed, ancestry, national origin, handicap or disability, age, sex, sexual orientation, or gender
identity or expression, genetic information, veteran status, marital status, family status, or other classification protected by applicable law; and (3)
that it does not discriminate in the employment of administrators on the basis of race, color, religious creed, ancestry, national origin, handicap or
disability, age, sex, sexual orientation, or gender identity or expression, genetic information, veteran status, marital status, family status, or other
classification protected by applicable law and that its governance structure includes diverse membership broadly representative of the public
interest as may be required by law or regulation.
There shall be no retaliation against any applicant, employee, or student for filing a harassment or discrimination complaint, or assisting, testifying,
or participating in the investigation of such a complaint. Any applicant, employee, or student reporting sexual or other harassment or discrimination
will also be protected from reprisals or retaliation by the College, any supervisors, and/or co-workers as a result of such complaint(s).
The C
ollege is committed to be in compliance with the Pennsylvania Human Relations Act (43 P. S. §§ 951-962.2) and the Pennsylvania Fair
Educational Opportunities Act (24 P.S. § § 5001-5009). Employment and educational opportunities at Butler County Community College are
available to all as required by Title VI, Title VII, Title IX, Section 504 of the Rehabilitation Act, the Pennsylvania Fair Educational Opportunities Act,
the Pennsylvania Human Relations Act, and all applicable laws and regulations.
For information regarding equal education and employment opportunity including services, activities and facilities that are usable and accessible to
disabled persons, contact the Executive Director of Human Resources/Equal Opportunity Compliance Officer, Butler County Community College by
telephone at (724) 287-8711, Ext. 8353, or in writing at 107 College Drive, Butler, PA 16002. If an applicant, employee, or student is physically or
mentally disabled, he/she may request accommodations, academic adjustments, or auxiliary aids or services. Information on the College's services
for disabled students may be obtained from the Academic Counselor and Disabilities Coordinator at Ext. 8327. Employees or applicants should
contact the Executive Director of Human Resources/Equal Opportunity Compliance Officer at Ext. 8353 for more information.
For i
nformation regarding the College’s Grievance Procedure, visit our website at www.bc3.edu/humanresources/grievance-procedure.asp
or
contact the Executive Director of Human Resources/Equal Opportunity Compliance Officer, Butler County Community College by telephone at Ext.
8353 or in writing at the above address.
Butl
er County Community College selects applicants based on the requirements and qualifications of a particular position. It is not possible to
interview all applicants. We ask that you be as specific as possible when completing the application. Please feel free to add any information you
consider to be helpful in our selection of the most qualified applicant. Your application for employment will be given full consideration. Our main
source of information concerning your qualifications is this application. Your employment history and skills will be carefully evaluated. Only
employment applications with original signatures will be accepted. Any materials submitted will be the property of the College. A separate
application must be completed for each position for which you are applying.
INSTRUCTIONS: Type or print. Notify the College of any change in address subsequent to filing this application.
If more space is required, attach an additional sheet as needed.
Last Name First Name Middle Name/Initial Home Phone Number
Address Cell Phone Number
City State Zip Code Work Phone Number
Position of Interest E-Mail Address
XXX-XX-
Today’s Date
Last Four Digits of Social
Security Number
Please indicate any other name(s) used while employed
HR 11/3/2017
NAME
EMPLOYMENT: List below all employment for the past ten years, beginning with your most recent and accounting for all periods of
unemployment (volunteer/unpaid services are also acceptable).
Name of Employer Dates of Employment: From To
Address Phone #
Type of Business Final Salary
Position Held Full-Time Part-Time
Job Duties Reason for Leaving
May we contact this employer for reference? Yes No Supervisor’s Name
Name of Employer Dates of Employment: From To
Address Phone #
Type of Business Final Salary
Position Held Full-Time Part-Time
Job Duties Reason for Leaving
May we contact this employer for reference? Yes No Supervisor’s Name
Name of Employer Dates of Employment: From To
Address Phone #
Type of Business Final Salary
Position Held Full-Time Part-Time
Job Duties Reason for Leaving
May we contact this employer for reference? Yes No Supervisor’s Name
Name of Employer Dates of Employment: From To
Address Phone #
Type of Business Final Salary
Position Held Full-Time Part-Time
Job Duties Reason for Leaving
May we contact this employer for reference? Yes No Supervisor’s Name
HR 11/3/2017
NAME
EDUCATION: Please list High School, Technical, Trade, Professional, Military, or Business School, College and/or
Universities attended.
School Name
Major
Diploma/Degree
Received
Semester
Hrs/Credits
PERSONAL DATA:
Please indicate the type of position for which you are interested:
Full-Time Part-Time Temporary Summer Only
If part-time: Hours, days available
Anticipated Salary Date Available
Are you a U.S. citizen? Yes No If no, please indicate visa classification
Are you legally eligible to work in the United States? Yes No
(proof of identity and eligibility will be required upon employment)
Are you over 18 years of age? Yes No If no, you will be required to provide authorization to work.
Please indicate the name(s) and relationship of any relatives currently working for Butler County Community College
Have you been charged with a criminal offense which constituted a felony or misdemeanor or have you ever plead guilty or been convicted
of a felony or misdemeanor?
Yes No If yes, please explain (a conviction will not necessarily disqualify an applicant).
Please list professional memberships, professional affiliations, extracurricular activities and accomplishments (do not include information
that relates to race, ethnicity, political, or religious affiliation).
Please list any licenses, certificates, or special skills that you possess related to this job.
Indicate computer/software experience
Clerical applicants only: Typing – WPM
HR 11//2017
NAME
REFERENCES: List below the names, addresses, and telephone numbers of three professional references, who are not related to you,
who have knowledge of your qualifications for the position for which you are applying.
Telephone Years Title/
Name Address Number Known Relationship
APPLICANT’S CERTIFICATION:
I hereby certify that the statements and information contained in this application and other materials submitted are true, complete and
correct to the best of my knowledge and belief, and I authorize Butler County Community College, and my former employers listed to verify
the accuracy.
I release all parties and persons from any and all claims, lawsuits, and any liability what-so-ever for damages that may result from
furnishing such information to Butler County Community College.
I understand and agree that:
• Any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive
an offer, or, if I am hired, in my dismissal from employment.
• All offers of employment are conditioned on the provision of satisfactory proof of an applicant’s identity and legal authority to
work in the U.S.
• Filing an application at the College does not indicate there are positions open or obligate the College in any way.
• The information contained herein will be held confidential and is, together with any attached papers, the property of the
College.
Candidates who are extended a conditional offer of employment at Butler County Community College may be required to undergo a
complete medical examination at the time of appointment.
In consideration of my employment, I agree to fully adhere to the policies, rules, and regulations of employment with Butler County
Community College and in the absence of a collective bargaining agreement I understand that my employment and compensation can be
terminated at-will, with or without cause, and with or without notice, at any time, whether at my option or at the option of Butler County
Community College. Compensation, benefits, salary/hourly rate, hours of work, policies, rules, and regulations of employment and other
working conditions are subject to change at the College’s discretion.
Signature of Applicant Date
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Application (Butler County Community College)

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Completed 25 July 2020

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