Fillable Application Employment General Information materials become part of (Heartland Community College)

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Application Employment General Information materials become part of (Heartland Community College)

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The Application Employment General Information materials become part of (Heartland Community College) form is 2 pages long and contains:

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  • 8 check-boxes
  • 96 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Heartland Community College

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The Employment Application is used to collect information in a standard format from all employment applicants. Application
materials become part of the personnel file of applicants who are employed by the College.
General Information
Date Type of Employment Sought (check all that apply)
Full-time Part-time HCC Student Employment (must be an enrolled HCC student)
Regular Temporary
Specific Position(s) Applied For
How did you learn about this position?
Heartland Community College website Other (specify):
Heartland Community College employee or student
Name (First Middle Initial Last)
Preferred name if different from above
Address City State Zip Code
Primary Phone Number Alternate Phone Number Email Address
Have you ever been employed by Heartland Community College previously? Yes No
If yes, provide job title, approximate dates, and name of supervisor.
Are you retired through the State Universities Retirement System (SURS)? Yes No
Education and Formal Training (include high school last attended and any post-secondary
educational institutions attended in order of attendance)
Name of School City, State Area of Study/Major Type of
Diploma/Degree
Current Licenses and Certifications
Type Expiration (if applicable)
Additional Training and Skills
List additional training, skills, and/or knowledge you possess that you believe enhance your employment
qualifications.
Return Employment Application to:
Human Resources Office
CCB 1300
Phone: 309-268-8130
Email: humanresources@heartland.edu
Main Campus: 1500 W. Raab Road
Normal, IL 61761
Phone: 309-268-8000
TDD: 309-268-8030
Website: www.heartland.edu
Employment
Application
Heartland Community College is an Equal Opportunity Institution. The College provides equal employment opportunities
without regard to race, color, religion, sex, gender, sexual orientation, national origin, age, disability, marital status, status
as a veteran, or any other protected status under federal, state, or local laws.
Work Experience (begin with most recent employment)
1. Employer Name City State
Position Title Avg Hours/Week From (Month/Year) To (Month/Year)
Supervisor Name/Title Phone Number May we contact this
employer now?
Yes No
Reason for leaving
2. Employer Name City State
Position Title Avg Hours/Week From (Month/Year) To (Month/Year)
Supervisor Name/Title Phone Number May we contact this
employer now?
Yes No
Reason for leaving
3. Employer Name City State
Position Title Avg Hours/Week From (Month/Year) To (Month/Year)
Supervisor Name/Title Phone Number May we contact this
employer now?
Yes No
Reason for leaving
4. Employer Name City State
Position Title Avg Hours/Week From (Month/Year) To (Month/Year)
Supervisor Name/Title Phone Number May we contact this
employer now?
Yes No
Reason for leaving
Other Information and Conditions
Are you legally eligible for employment in the United States and can you provide proof upon hire? Yes No
Employment is contingent upon a review and verification of documents establishing identity and work authorization in
accordance with Form I-9.
Have you ever been dismissed or asked to resign from a position? Yes No
If yes, please explain below or in an attachment. This is not intended to include layoffs that result from a reduction in
force or company shut-down.
I certify that the information provided on this application is true and complete. I further understand that any
false statements or misrepresentations made by me on this application or any supplement thereto will be sufficient
grounds for immediate discharge.
I authorize Heartland Community College to make a thorough investigation of my past employment activities, I
agree to cooperate in such a review, and I release from all liability or responsibility all persons, companies or
corporations supplying such information.
I understand that it is the practice of Heartland Community College to conduct criminal background checks on all
employees.
I understand that it is the practice of Heartland Community College to verify post-secondary education and that I
may be requested to release my educational transcript or other records if necessary.
I agree to comply with safety rules and other rules and regulations of Heartland Community College, including
the use of protective clothing and devices as required by the College.
I understand that nothing on this application is intended to create or imply a contractual or employment
relationship.
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Application Employment General Information materials become part of (Heartland Community College)

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Completed 15 September 2020

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