The information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact
in my application, resume, or any other materials, or during any interviews, can be justication for refusal of employment, or if employed, termination from
Monroe County Community College.
I give Monroe County Community College the right to contact and obtain information from all references, employers, educational institutions and to
otherwise verify the accuracy of the information contained in this application. I hereby release from liability Monroe County Community College and its
representatives for seeking, gathering and using such information and all other persons, employers, or organizations for furnishing such information.
Please list name and telephone number of three business/work references who are not related to you and are not previous supervisors. If
not applicable, list three school or personal references who are not related to you.
Phone Number
Name
References
Pre-Employment Statement (Please Read Carefully)
Signed ________________________________________________________ Date _______________________________________
Typed signature will be accepted
Relationship
#3526 — Rev. 3/19
Past and Present Employment Beginning with most recent or current employer.
Name and Address of Employer and Type of Business
Briey describe the nature of the work.
Reason for Leaving
Name of Supervisor & Phone #
Fr o m To
Mo./Yr. Mo./Yr.
Name and Address of Employer and Type of Business
Briey describe the nature of the work.
Reason for Leaving
Name of Supervisor & Phone #
Fr o m To
Mo./Yr. Mo./Yr.
Name and Address of Employer and Type of Business
Briey describe the nature of the work.
Reason for Leaving
Name of Supervisor & Phone #
Fr o m To
Mo./Yr. Mo./Yr.
