Please list any experiences, skills, or abilities that you feel especially qualify you for the position you are applying for.
(Such as software knowledge, mechanical knowledge, etc.)
Special Skills
Position Desired:
Degree EarnedName of SchoolSchool
High
School
College
Other
Record of Education
Application for Support Staff and Maintenance Positions
A person with a disability requiring accommodations for completing the application
and/or the interview process should notify the Oce of Human Resources
Telephone Number
Alternative Phone Number
Email Address
Name:
Last First Middle
Address:
Number Street
City State Zip
Position Desired:
Today's Date
Attn: Human Resources Office
1555 South Raisinville Road
Monroe, MI 48161-9746
(734) 384-4110
FAX (734) 687-6057
Monroe County Community College is an equal opportunity institution and adheres to a policy that no qualied person shall be discriminated against
because of race, color, religion, national origin or ancestry, age, gender, marital status, disability, genetic information, sexual orientation, gender identity/
expression, height, weight or veteran's status in any program or activity for which it is responsible. e Colleges Equal Opportunity Ocer, Title IX,
and Section 504/ADA Compliance Ocer is the Director of Human Resources, phone 734.384.4245.
Are you at least 18 years of age? n Yes n No
Are you legally eligible for employment in the United States?
n Yes n No
(Proof of identity and eligibility will be required upon employment)
Will you now or in the future require sponsorship for employment visa status? n Yes n No
If selected for a position at Monroe County Community College, when would you be available for employment?
General Information
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 justication 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
Briey 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
Briey 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
Briey describe the nature of the work.
Reason for Leaving
Name of Supervisor & Phone #
Fr o m To
Mo./Yr. Mo./Yr.
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