Fillable CISCO COLLEGE Employment Application (Cisco College)

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CISCO COLLEGE Employment Application (Cisco College)

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Country of origin: US
File type: PDF

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CISCO COLLEGE
Employment Application
Cisco College is an equal opportunity employer
Please Type or Print in ink clearly.
Personal Data
Last Name First Name Middle Name Social Security Number
Present Address (Street) (City, State, Zip) Phone
Type of Employment: Full-time Part-time
Date Available:
Position that you are applying for:
Have you ever filed an application with us before?
Y
es No
Location Preference:
Cisco Abilene
No
Are you a current/former CC employee?
If former employee, please state separation date:
Yes No
Will you work weekends?
Yes No
Preferred Hours:
NAME: TITLE:
RELATIONSHIP:
Educational and Professional Training
Institute/Type
of School
Dates Attended
Date
Graduated
Type of Degree/Diploma
Major/Minor
Fields of Study
Name and Location
of School
From
To
Undergraduate
College or
Universities
Graduate
Schools
Technical or
Vocational
Schools
Special Training/
Skills/
Qualifications
License/Certifications
LVN,RN, C.P.A,etc...
High School Graduate or GED? Yes____No____ If Yes, name and location of high school or GED_________________________________________
Email Address:
Date
Issued
Date
expires
Issued by/Location of issuing authority
(State or other authority) (City & State)
License No.
Yes
Will you work irregular hours?
1
06/2020
Are you related by kinship or marriage to any current employee or any member of the Board of Regents at Cisco College?
Yes No
If Yes, give name, title, & relationship:
Print Application
Employment History
Please list last three positions held with most recent first. Complete all applicable data. DO NOT refer to resume.
Name of Employer Job Title or Position Held Date Started Date Left
Address City State Zip
Beginning Salary $
Hour Week Month
Ending Salary
$
Hour Week Month
Supervisors Name & Title Reason For Leaving
May we contact this employer? Yes
No
Telephone Number:
Description of Duties
Name of Employer Job Title or Position Held Date Started Date Left
Address City State Zip
Beginning Salary $
Hour Week Month
Ending Salary
$
Hour Week Month
Supervisors Name & Title Reason For Leaving
May we contact this employer? Yes
No
Telephone Number:
Description of Duties
Name of Employer Job Title or Position Held Date Started Date Left
Address City State Zip
Beginning Salary $
Hour Week Month
Ending Salary
$
Hour Week Month
Supervisors Name & Title Reason For Leaving
May we contact this employer? Yes No Telephone Number:
Description of Duties
Explain any periods of unemployment
2
06/2020
Skills Inventory
In order to better match your qualifications with the appropriate positions, please complete by listing the total number of
years of experience or the skill level you have obtained in the following categories:
Clerical
Professional
Skilled Crafts/Maintenance
Bookkeeping
Accounting
Yrs
Carpentry Yrs
Receptionist/Secretarial
Interviewing
Yrs
Electrical Yrs
Computer/ Word Processing
Management
Yrs
Painting Yrs
10 Key
Plumbing Yrs
Custodial Yrs
Grounds keeping Yrs
Please list any skills you may have which relate to the position for which you are applying (include U. S. Armed Forces
where applicable).
Faculty Position Only:
Statement of Philosophy of Education
On a separate sheet of paper please state your education philosophy, especially as it relates to the community college.
Professional Activities and Honors
Personal References
List four persons who are NOT related to you, and can furnish information about your work performance. Do not repeat supervisors
furnished in your employment record.
Name
Position, Title, or Occupation
Phone #
Street City State & Zip code
Have you ever been convicted of a felony? Yes No
If so, give year, location, and nature of conviction and disposition.
If hired, can you provide proof that you are legally entitled to work in the United States? Yes
No
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States
and to complete the required employment eligibility verification upon hire.
**Cisco College is unable to sponsor applicants for work visas.**
PLEASE READ CAREFULLY and SIGN BELOW
I certify that all information and statements contained in this application (and accompanying resume, if any) are true, complete, and correct
to the best of my knowledge and belief. I understand that any false statements or omissions made by me in connection with my application may be
grounds for rejection of my application or for dismissal after employment. If employed, I agree to abide by the policies, procedures, rules, and
regulations of Cisco College. I acknowledge the College's prerogative of revising, at any time, its policies, procedures, rules, and regulations and I
agree to abide and be governed by such revisions.
X
X
Signature of Applicant
Date
3
06/2020
CISCO COLLEGE
CRIMINAL HISTORY RECORD CHECK RELEASE FORM
It is the policy of the College to obtain a criminal history record on each of its potential employees in security
sensitive position*. Please sign the release form below so that we may obtain a criminal history record check.
Personal Data
Last Name First Name Middle Name Social Security Number
Current Address (Street) (City, St Zip) Phone
Driver’s License Number State
Birth Date Sex
Counties of Residence Since High School:
PLEASE READ CAREFULLY and SIGN BELOW
I hereby authorize Cisco College to conduct a criminal history record check and all necessary police record
inquiries to evaluate my acceptability for employment.
X________________________X______________________________________________
Signature of Applicant
Date
Return form to:
Cleared Criminal History Record
Date Checked:_________________
Done by: _________________
(The above data, i.e., sex and birth date, will not be used for employment purposes, but only for identification purposes when the criminal history record
check is conducted. A report showing a record of a conviction will not automatically eliminate an individual from employment consideration or offer of a
contract, but it may do so. The College will examine the date and nature of the offense, the severity of the offense, and its relation to the employment
position sought.)
*Security sensitive positions include all positions which require employees to handle currency, have access to a computer terminal, have access to a
master key, or to work in security-sensitive areas.
Human Resources Office
Cisco College
101 College Heights
Cisco,Tx 76437
4
06/2020
5
DISCLOSURE AND AUTHORIZATION FOR BACKGROUND REPORTS
Fair Credit Reporting Act Disclosure
______________________, including its parents, subsidiaries, affiliates, and agents (“COMPANY”)
may obtain a consumer report on you for _______________________, purposes. This report may be in
the form of a consumer report and/or an “investigative consumer report.” An investigative consumer
report includes information as to your character, general reputation, personal characteristics and mode of
living which can involve personal interviews with sources such as your neighbors, friends, or associates.
Consumer Reports may include information regarding your credit history, criminal history, identity
verification, motor vehicle records (“driving records”), verification of your education or employment
history, worker’s compensation injuries, or other background checks. Credit history will only be requested
if such information is substantially related to the duties and responsibilities of the employment position. You
have the right, upon written request made within a reasonable time after receipt of this notice, to request
disclosure of the nature and scope of any investigative consumer report conducted by Choice Screening,
8668 Concord Center Dr., Englewood, CO 80112, 1-877-929-7878, www.choicescreening.com.
These reports may be obtained at any time after the COMPANY receives authorization from you,
including any time during the period of your employment or contract if the COMPANY hires or contracts with
you or if you already work or contract for the COMPANY.
CHOICE SCREENING, or another consumer reporting agency, will obtain the reports on you.
Authorization
USA Applicants Only: I acknowledge receipt of the attached A SUMMARY OF YOUR RIGHTS UNDER THE
FAIR CREDIT REPORTING ACT and certify that I have read and understand the document.
Applicants with Personal Data from Outside the USA only
: I acknowledge receipt of the attached DATA
PRIVACY NOTICE and certify that I have read and understand the document.
I hereby authorize the COMPANY or its authorized agents, for _ __________, purposes,
to obtain or prepare consumer report(s) and investigative consumer report(s) at any time after the COMPANY
receives this authorization, including any time that I may be employed by or in contract with the COMPANY.
I hereby authorize law enforcement agencies, public and private schools, federal, state and local
agencies and courts, credit bureaus, information bureaus, current and former employers, financial institutions,
licensing agencies, governmental agencies, the military, and other individuals and entities to provide any and
all information that is requested by CHOICE SCREENING, 8668 Concord Center Dr., Englewood, CO 80112,
1-877-929-7878, or other consumer reporting agencies or the COMPANY. In accordance with the host nation’s
laws and the laws applicable to me depending on my location regarding the release of information, I authorize
the release and transmittal of information from any country to the above listed parties, the clients, and/or their
agents or vendors located in any country, including countries outside the European Union that may have a
different level of data protection or inadequate data protection laws as defined by the European Commission.
I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the
original.
Applicant/Employee Name (Printed): ______________
Applicant/Employee Signature: ______________
Date: _________
Cisco College
Employment
Employment
6
STATE SUMMARY OF RIGHTS
_______________________, including its parents, subsidiaries, affiliates, and agents
(“COMPANY”) uses consumer reports for employment purposes. The consumer reporting
agency COMPANY uses is: Choice Screening | 8668 Concord Center Dr. | Englewood, CO 80112
Toll Free: 1-877-929-7878. Information describing its privacy practices can be reviewed at:
https://www.choicescreening.com/privacy-policy.
☐ - If you are applying for employment or live in one of the following states: California, Minnesota,
or Oklahoma and would like to request a copy of your Consumer Report please check the box.
☐ - If you are applying for employment or live in any states not listed and would like to request a copy
of your Consumer Report please check the box.
California, Connecticut, Maryland, Oregon, Vermont and Washington State Applicants Only (AS
APPLICABLE): I understand that COMPANY will not obtain information about my credit history,
credit worthiness, credit standing, or credit capacity unless: (i) the information is required by law; (ii) I
am seeking employment with a financial institution (California, Connecticut and Vermont only — in
California the financial institution must be subject to Sections 6801-6809 of the U.S. Code and in Vermont
it must be a financial institution as defined in 8 V.S.A.§ 11101(32) or a credit union as defined in 8 V.S.A.
§ 30101(5)); (iii) I am seeking employment with a financial institution that accepts deposits that are
insured by a federal agency, or an affiliate or subsidiary of the financial institution or a credit union share
guaranty corporation that is approved by the Maryland Commissioner of Financial Regulation or an entity
or an affiliate of the entity that is registered as an investment advisor with the United States Securities and
Exchange Commission (Maryland only); (iv) I am seeking employment in a position which involves
access to confidential financial information (Vermont only); (v) I am seeking employment in a position
which requires a financial fiduciary responsibility to the employer or a client of the employer, including
the authority to issue payments, collect debts, transfer money, or enter into contracts (Vermont only); (vi)
COMPANY can demonstrate that the information is a valid and reliable predictor of employee
performance in the specific position being sought or held; (vii) I am seeking employment in a position
that involves access to an employer’s payroll information (Vermont only); (viii) the information is
substantially job related, and the bona fide reasons for using the information are disclosed to me in writing,
(Connecticut, Maryland, Oregon and Washington only);(ix) I am seeking employment as a covered law
enforcement officer, emergency medical personnel, firefighter police officer, peace officer or other law
enforcement position (California, Oregon and Vermont only - in Oregon the police or peace officer
position must be sought with a federally insured bank or credit union and in Vermont the law enforcement
officer position must be as defined in 20 V.S.A. § 2358, the emergency medical personnel must be as
defined in 24 V.S.A. § 2651(6), and the firefighter position must be as defined in 20 V.S.A. § 3151(3));
(x) the COMPANY reasonably believes I have engaged in specific activity that constitutes a violation of
law related to my employment (Connecticut only); (xi) I am seeking a position with the state Department
of Justice (California only); (xii) I am seeking a position as an exempt managerial employee (California
only); and/or (xiii)) I am seeking employment in a position (other than regular solicitation of credit card
applications at a retail establishment) that involves regular access to all of the following personal
information of any one person: bank or credit card account information, social security number, and date
of birth„ I am seeking employment in a position that requires me to be a named signatory on the employer’s
bank or credit card or otherwise authorized to enter into financial contracts on behalf of the employer, I
am seeking employment in a position that involves access to confidential or proprietary information of
the Company or regular access to $10,000 or more in cash (California only).
Cisco College
7
Notice to California Applicants: You have the right under Section 1786.22 of the California Civil Code
to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (PTZ) Monday through Friday) to
obtain all information in your file for your review. You may obtain such information as follows: 1) In
person at the Agency’s offices, which address is listed above. You can have someone accompany you to
the Agency’s offices. Agency may require this third party to present reasonable identification. You may
be required at the time of such visit to sign an authorization for Agency to disclose to or discuss your
information with this third party; 2) By certified mail, if you have previously provided identification in a
written request that your file be sent to you or to a third party identified by you; 3) By telephone, if you
have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel
to explain any information in your file to you and if the file contains any information that is coded, such
will be explained to you.
Notice to New York Applicants: For consumers applying for work in New York: I acknowledge
receiving a copy of Article 23-A of the New York Correction Law _________ (Initials).
Notice to Washington Applicants: You have the right if the report is provided to an employer in the
State of Washington, to contact the following office for more information regarding your rights under
Washington state law in regard to these reports: State of Washington Attorney General, Consumer
Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, (206) 464-7744.
By signing below, I acknowledge receipt of this state summary of rights.
Applicant/Employee Signature:
Date:
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CISCO COLLEGE Employment Application (Cisco College)

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Completed 27 July 2020

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