Fillable Application for Professional Position (Lake Land College)

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Application for Professional Position (Lake Land College)

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Application for Professional Position
Return to: Human Resources
Lake Land College
5001 Lake Land Blvd.
Mattoon, IL 61938
Phone: (217) 234-5410 or (217) 234-5210
www.lakelandcollege.edu
If you are a qualifi ed applicant with a disability and need reasonable accommodations to ensure an equal opportunity in applying for this position,
please contact the Director of Human Resources at Lake Land College, (217)234-5210 or apply online at
www.lakeland.cc.il.us/human_resources/employ_opportunity
Note to applicant: Only completed applications will be accepted. The information provided will become part of your offi cial personnel fi le if hired.
(Please print in black ink)
Date:
Position(s) for which you are applying:
Full Time: Part Time: Date Available:
Name (Print):
Last First Middle
Mailing address:
# and Street, or R.R. and box
City State Zip
Phone: ( )
Have you ever worked for Lake Land College? No Yes Year(s):
Positions:
Are any of your educational or past employment records under another name?
No Yes
If yes, please list name(s):
Do you have any relatives currently working for Lake Land College? No Yes
If yes, please state name(s), positions(s) and your relationship:
Have you ever been convicted or plead guilty to any misdemeanor or felony in any state?
No Yes If yes, please explain in detail the nature of the conviction or guilty plea:
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the
offense, the surrounding circumstance, and the relevance of the offense to the position(s) applied for may, however, be considered.)
Cell : ( )
Email:
College or
University
City, State # of Years
completed
Did you
graduate?
Degree
Received
Y / N
Y / N
Y / N
Y / N
Other Special
Training
Professional Preparation
Length of Service:
At Discharge:
Complete this section if you served in the U.S. Armed Forces
Branch of Service:
Rank: Upon Entrance:
Please list any special training and/or service schools attended:
Teaching/Counseling/Administrative Experience:
City, State Name of institution Subjects and Level Dates (Years)
City, State Name of institution Subjects and Level Dates (Years)
City, State Name of institution Subjects and Level Dates (Years)
City, State Name of institution Subjects and Level Dates (Years)
Please list employment starting with present or most recent employer
Are you on a lay-off and subject to recall?
Yes No
How did you learn about this position?
1. Position Title:
Years of Service:
MM/YYYY MM/YYYY
Employer’s Name:
Address:
Supervisor’s Name:
Reason for leaving:
Phone:
May we contact your employer? Yes No
Duties:
2. Position Title:
Years of Service:
MM/YYYY MM/YYYY
Employer’s Name:
Address:
Supervisor’s Name:
Reason for leaving:
Phone:
May we contact your employer? Yes No
Duties:
3. Position Title:
Years of Service:
MM/YYYY MM/YYYY
Employer’s Name:
Address:
Supervisor’s Name:
Reason for leaving:
Phone:
May we contact your employer? Yes No
Duties:
4. Position Title:
Years of Service:
MM/YYYY MM/YYYY
Employer’s Name:
Address:
Supervisor’s Name:
Reason for leaving:
Phone:
May we contact your employer? Yes No
Duties:
References (Do not list relatives, friends, or neighbors)
1.
Name:
Address:
City, State, Zip:
Email:
Phone:
2.
Name:
Address:
City
, State, Zi
p:
E
mail:
Phone
:
3. Name:
Address:
City
, State, Zi
p:
E
mail:
Phone
:
Policy Statement
Lake Land College is an Equal Opportunity Employer. We welcome you as an applicant for employment. Your application will be considered along with
others in competition for the position (s) in which you express interest. It is the policy of Lake Land College to provide equality of opportunity in
employment to all persons. This policy prohibits discrimination because of race, color, sex, religion, national origin, political affiliation, disability, age,
or marital status in all aspects of the college's policies, programs, practices, and operations. This policy applies to all phrases of full-time, part-time,
and temporary employment.
All information contained or connected with this application will be considered personal and confidential and will only be used in conjunction with
your consideration for employment.
Please Read Carefully
Federal law prohibits the employment of unauthorized aliens. Every person hired must complete the I-9 form, which is used to verify a person's right to
work in the United States. Any offer of employment by Lake Land College is contingent upon the submission of satisfactory proof of identity and legal
authorization to work in the United States. Failure to submit adequate proof annuls any offer of employment by Lake Land College.
Are you authorized to work lawfully in the United States for Lake Land College? Yes ________ No
________
Will you now or in the future require Lake Land College to commence ("sponsor") an immigration case in order to employ you (for example, H-1B or other
employment based immigration case)? This is sometimes called sponsorship for an employment based visa status. Yes ________ No________
Public Act 85-827 states that an employee of a "State Agency" who is in default of an education loan for six months or more, and in an
amount of $600 or more, must make loan repayment arrangements as a condition of employment.
Are you at this time in default on any educational loan(s)? Yes
________ No________
If yes and you are hired, written verification of satisfactory repayment arrangements must be provided within six months from the
date of hire. Failure to provide adequate proof will result in termination of employment with Lake Land College.
SURS ANNUITANT CERTIFICATION
I hereby certify that I AM NOT ________ I AM ________presently receiving an annuity (retirement payments from SURS
(State Universities Retirement
System).
If I am presently receiving an annuity from SURS, a history of my current and former employment with any SURS employer is attached. I understand
that the College may require me to provide additional information and/or documentation regarding my employment history with SURS employers to
ensure compliance with P.A. 97-968.
I have carefully reviewed this application form and certify that the facts set forth in the employment application are accurate and complete. I understand that if the College employs me, any false statement
or misrepresentation on this application will be sufficient cause for dismissal or immediate cancellation of any contract executed between the applicant and Lake Land College. I understand, however, that
the College is not obligated to provide employment and I am not obligated to accept employment. Nothing in this application is intended to create any contract of employment or to create any rights in the
nature of a contract of employment. I understand that unless I am employed under an express written contract authorized by the Board of Trustees of Lake Land College, my employment with the College
is at will and nothing shall restrict my right as an employee or the right of the College as an employer to terminate an employment at any time and for any reason. I understand and agree that all
information furnished in this application may be verified by the College or its authorized representatives. I waive any right I may have to notice from any individuals and organizations referred to in this
application and any law enforcement organization to give the College all information relative to such verification and hereby release such individuals, organizations, and the College from any and all liability
for any claim or or damage resulting there from.
I hereby acknowledge that I have read and understand the above statement.
No employment is final until formal approval is granted by the Lake Land College Board of Trustees
Date:_______________________
Signature:__________________________________
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Application for Professional Position (Lake Land College)

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Completed 10 March 2022

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