EMPLOYMENT APPLICATION PROCESS AT MONTGOMERY COMMUNITY COLLEGE
To be considered for employment, you must fully complete and sign the attached EMPLOYMENT APPLICATION, and
the TYPE OF EMPLOYMENT forms. We do request that you enclose copies of all your transcripts above the high school
level. OFFICIAL TRANSCRIPTS WILL BE REQUIRED UPON EMPLOYMENT. In addition, you may enclose resumes,
certificates, references, etc. Our general process is that your application is placed in our active files for a period of 90
days from the date your application/re-activation request was received in our office. After deactivation, your file will be
transferred to our inactive files which are retained for approximately two years after the current year and then shredded.
Should you wish your file to return to the active files, you must contact us in writing. Your file will then be reactivated for
another three months from the date we receive the reactivation notice. Further reactivation will be handled in a like
manner. When the college has a permanent vacancy, we do attempt to review all the active files, looking for any that
might meet the minimum qualifications for the vacancy. Also, if you have indicated an interest in temporary teaching on
your application, your file will be available for those who make hiring decisions.
The following briefly describes our employment process for permanent positions:
The opening is advertised and applications are accepted through the specified deadline date. After the deadline,
applications are reviewed by Personnel to identify those candidates meeting the minimum qualifications.
Candidates must supply copies of college transcripts prior to deadline. The files of those meeting the minimum
qualifications are forwarded to the Selection Committee.
The Committee is generally a broad-based one with individuals both from the department where the open position
exists, and from other related areas of the college. The Committee reviews all of the qualified applications and
recommends a list for interviews. Once the list is approved, those candidates are called and interviews are
scheduled.
After the interview, the Committee goes through a ranking procedure, checks references, and sends its
recommendation to the President of the College for review and submission to the College Board of Trustees for
approval. Once final approval is obtained, the selected individual is called and offered the position. A formal offer
of employment will be forwarded by the President, pending approval by the Board of Trustees where necessary.
As you can see, our permanent employment process is involved and can take eight to twelve weeks. As a result of this
process, however, we feel the best qualified candidate is selected for the position without regard to race, creed, sex,
national origin, or disability. Should you have any questions concerning the above, please feel free to contact me at (910)
898-9634.
In compliance with the
Jeanne Clery Disclosure Campus Security Policy and Campus Crime Statistics Act
, MCC invites you
to visit our website at www.montgomery.edu/security.htm
to access the College's Annual Security Report. Please contact
me if you would like a written report mailed to you.
We look forward to receiving your application. Your interest in this institution is appreciated.
Melisa Bond
Personnel
An Equal Employment Opportunity Educational Institution
Revised 03-2005
Montgomery Community College
1011 Page Street, Troy, North Carolina 27371
Please retain this first page for your information and return all of the following pages to
Montgomery Community College as part of your employment application.
Clear Form
Montgomery Community College
1011 Page Street, Troy, North Carolina 27371
TYPE OF EMPLOYMENT
Please specify all of the types of positions in which you are interested. Check as many as you are willing
to consider:
ADMINISTRATIVE: INSTRUCTIONAL:
Full-time Administration Full-time Instruction
Part-time Administration Part-time Curriculum Instruction
Part-time Continuing Education
OTHER
Other. Describe:
HOURS/WEEK
-ENDS:
f willing to do part-time work, please specify what evening and other part-time hours you would consider
working, and also if you would consider working on Saturdays:
Please state your teaching area:
Please state your administrative specialty:
Please print your name, address, phone number, and date on this form below:
DATE:
NAME:
ADDRESS:
PHONE:
An Equal Employment Opportunity Educational Institution
________________
________________________________
______________________
___
___
MCC IS AN EQUAL EMPLOYMENT OPPORTUNITY EDUCATIONAL INSTITUTION.
EMPLOYMENT APPLICATION
INSTRUCTIONS FOR COMPLETING APPLICATION FORM
MONTGOMERY COMMUNITY COLLEGE
1011 PAGE STREET, TROY, NORTH CAROLINA 27371
NOTICE:
1. TO BE CONSIDERED FOR STATE EMPLOYMENT, YOU MUST ANSWER ALL QUESTIONS AND COMPLETE ALL SECTIONS OF THIS
APLICATION FORM.
2. THE STATE EMPLOYES ONLY US CITIZENS OR ALIENS WHO CAN PROVIDE PROOF OF IDENTITY AND WORK AUTHORIZATION WITHIN 3
WORKING DAYS OF EMPLOYMENT.
3. MALES SUBJECT TO MILITARY SELECTIVE SERVICE REGISTRATION MUST CERTIFY COMPLIANCE TO BE ELIGIBLE FOR STATE
EMPLOYMENT (G.S. 143B-421.1). SEE AVAILABIITY BLOCK.
4. A BACKGROUND CHECK IS REQUIRED FOR ALL PROSPECTIVE EMPLOYEES. YOUR SIGNATURE IS REQUIRED IN ORDER TO OBTAIN
THIS INFORMATION. (See page 5)
WHEN COMPLETING THIS APPLICATION, PLEASE MAKE SURE YOU:
1. USE A BLACK INK PEN OR TYPEWRITER.
2. COMPLETE THE SECTION OF EQUAL OPPORTUNITY INFORMATION LISTED AT BOTTOM OF THIS PAGE.
3. GIVE COMPLETE INFORMATION ON YOUR ECUCATION AND WORK HISTORY ("SEE RESUME" IS NOT ACCEPTABLE).
4. LIST SEPARATELY EACH JOB HELD AND YOUR DUTIES FOR EACH POSITION WHEN YOU WORKED FOR ONE EMPLOYER AND HELD
MORE THAN ONE POSITION.
5. CHECK FOR ACCURACY. SIGN AND DATE YOUR APPLICATION.
NOTE: IF YOU FORGET TO COMPLETE SOME PART OF THE APPLICATION OR DO NOT INCLUDE REQUESTED
INFORMATION, YOUR APPLICATION MAY NOT BE CONSIDERED.
Thank you for your interest in Montgomery Community College. It is the goal of the College to find the best qualified people available to serve the
citizens of North Carolina. Although everyone who applies cannot be hired, your application will be given every consideration.
Equal Opportunity Information
State Government policy prohibits discrimination based on race, sex, color, creed, national origin, age or
disability. Sex or age is a bona fide occupational qualification in a small number of State jobs. The information
requested below will in no way affect you as an applicant. Its sole use will be to see how well our recruitment
efforts are reaching all segments of the population.
Date of Birth Ethnic Group
(mo) (day) (year)
Sex:
1. White (non-Hispanic)
2. Black (non-Hispanic)
3. Hispanic (Mexican, Puerto Rican, Cuban,
Central or South American, other Spanish
origin regardless of race)
4. Asian (including Pacific Islander)
5. American Indian (including Alaskan native)
Male Female
DISABILITY: "Disability means, with respect to an individual: (1) a physical or mental impairment that substantially limits one or more of
the major life activities of such individual; (2) a record of such an impairment; or (3) being regarded as having such an impairment" (Americans
with Disabilities Act of 1990). Persons without a disability should check item A.
The reporting of a disability is strictly VOLUNTARY. Persons with disabilities who DO NOT WISH to report their disabilities should check item
A. Information reported on this form will be kept confidential as required by State law. Public disclosure of this information without your
consent would be a violation of G.S. 126-27
A None/Prefer not to report
B Blind or severely visually impaired
C Deaf or severely hearing impaired
D Loss or limited use of arms and/or hands
E Non-ambulatory (must use wheelchair)
F Other orthopedic impairment (including amputation,
arthritis, back injury, cerebral palsy, spina bifida, etc.)
G Respiratory impairment
H Nervous system/Neurological disorder
I Mentally restored
J Mental retardation
K Learning disability
L Others (heart disease, diabetes speech impairment)
M Other (please specify)
Applicant name: Date:
....................................................
1 2 3 4 1 2 3 4 5 6 7 8 9 10 11 12 GED
1 2 3 4
MCC IS AN EQUAL EMPLOYMENT OPPORTUNITY EDUCATIONAL INSTITUTION
1011 Page Street, Troy, NC 27371
EMPLOYMENT APPLICATION
Note: For your application to be considered, please complete all sections, do not write “See
Resume” and be sure to enclose all requested information.
Please Print or Type (SSN Voluntary, for Record-Keeping and Data Processing Only).
Are you a retired state employee? Yes No
Date of Application
Social Security Number Last Name First Name Middle Name
Address (Street number and name) City County
State Zip Code Phone (Home or where you can be reached) Business Phone
Availability
Do you now work
for the State of NC?
YES NO
Military Service
Are you related by blood or marriage to any person now working for the State YES NO
If yes, give name, relationship to you and the agency where employed.
If subject to Military Selective
Service registration, certify
compliance by initialing dotted line
Have you served honorably in the Armed Forces of the United States on active duty for reasons other than training? YES NO
Give dates of your qualifying active military service:
Entered: Separated: Branch: Rank
Are you a member of the Military Reserves? YES NO Branch: Rank:
CHECK the types of work you will accept: 1. Permanent full-time
5. Any of the preceding
2. Permanent part-time
6. Work involving Travel
3. Temporary full-time
7. Shift or Split Shift Work
4. Temporary part-time
If you are not available for work now, enter the earliest date you could begin work (mo/day/yr.)
Jobs Applied For
Enter below the specific title(s) of the job(s) for which you are applying. Please list no more than three on this application.
1. 2. 3.
Referral Source
Please indicate your referral source:
If you were referred by the Employment Security Commission (Job Service) please indicate which local office
:
Education
Circle highest grade completed:
GED
College
N/A
Graduate School
N/A
Under S/Q Hrs., list the hours of credit received and if they were semester (S) or quarter (Q) hours. Please Attach Photocopies of College Transcripts.
Schools Name and Location
High School
College(s)
University (s)
Graduate or
Professional
Other educational,
vocational school,
internships, etc.
Dates Attended (mo/yr)
From: To: Grad? S/Q Hrs. Major/Minor Course Work
YES
NO
YES
NO
YES
NO
YES
NO
Type of Degree
Received
Special training programs and seminars you have completed in the last five years (list):
If the job(s) applied for calls for specific courses, indicate those courses taken and credits received:
Current professional status: (List fields of work for which you have been registered)
Registration: State: No.
Registration: State: No.
Membership in professional, honorary, or technical societies (list):
DO NOT COMPLETE THIS BLOCK
DEGREES AND PROFESSIONAL CREDENTIALS
Have been verified
Will be verified within 90 days (G.S. 126-30)
Person Responsible:
(REV. 2/00 MCC)
Please list highest grade completed
________________________________________________
Licenses and certifications (List, giving dates and sources of issuance):
SKILLS
CHECK the following skills, experiences, etc., which you have:
Driver’s License
Number State
Chauffeur’s License
Number State
Car for use at work
Sign Language
Foreign language (specify)
Adding Machine/calculator
Typing (specify WPM)
Shorthand/speedwriting (specify WPM)
Legal transcription
Medical transcription
Braille
Word Processing
Other
Have you ever been convicted of an offense against the law other than a minor traffic violation? (A conviction does not mean you cannot be hired. The offense and how
recently you were convicted will be evaluated in relation to the job for which you are applying.) YES NO (If yes, explain fully on an additional sheet.)
Please sign here: Background check authorization
WORK HISTORY PAGE 1, Include volunteer experience; use Additional Sheets if Necessary; Selection Committees may not consider "see resume".
Current or Last Employer: Address:
Job Title: Supervisor’s Name Telephone Number No. Supervised by you:
Date Employed (mo/yr) Starting Salary
$ per
Ending or Current Salary
$ per
Reason for Leaving May We Contact Employer
YES NO
Date Separated (mo/yr) List major duties in order of their importance in the job:
Full Time Years Months
Part Time Years Months
If part time, number of hours
worked per week:
Employer: Address:
Job Title: Supervisor’s Name Telephone Number No. Supervised by you:
Date Employed (mo/yr) Starting Salary
$ per
Ending or Current Salary
$ per
Reason for Leaving
Date Separated (mo/yr) List major duties in order of their importance in the job:
Full Time Years Months
Part Time Years Months
If part time, number of hours
worked per week:
Employer: Address:
Job Title: Supervisor’s Name Telephone Number No. Supervised by you:
Date Employed (mo/yr) Starting Salary
$ per
Ending or Current Salary
$ per
Reason for Leaving
Date Separated (mo/yr) List major duties in order of their importance in the job:
Full Time Years Months
Part Time Years Months
If part time, number of hours
worked per week:
I certify that I have given true, accurate and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my
work, I authorize educational institutions, associations, registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I
authorize investigation of all statements made in this application and understand that false information or documentation, or a failure to disclose relevant information may
be grounds for rejection of my application, disciplinary action or dismissal if I am employed, and (or) criminal action. I further understand that dismissal upon employment
shall be mandatory if fraudulent disclosures are given to meet position qualifications (Authority: G.S. 126-30, G.S. 14-122.1.)
Signature of Applicant (unsigned applications will not be processed) Date
(Rev 2/00, MCC) Continuation Sheet -- Application for Employment
MONTGOMERY COMMUNITY COLLEGE
An Equal Opportunity/Affirmative Action Employer
Employer: Address:
Social Security Number Last Name
Job Title: Supervisor’s Name Telephone Number No. Supervised by you:
Date Employed (mo/yr) Starting Salary
$ per
Ending Salary
$ per
Reason for Leaving May We Contact Employer
YES NO
Date Separated (mo/yr) List major duties in order of their importance in the job:
Full Time Years Months
Part Time Years Months
If part time, number of hours
worked per week:
Employer: Address:
Job Title: Supervisor’s Name Telephone Number No. Supervised by you:
Date Employed (mo/yr) Starting Salary
$ per
Ending or Current Salary
$ per
Reason for Leaving
Date Separated (mo/yr) List major duties in order of their importance in the job:
Full Time Years Months
Part Time Years Months
If part time, number of hours
worked per week:
Employer: Address:
Job Title: Supervisor’s Name Telephone Number No. Supervised by you:
Date Employed (mo/yr) Starting Salary
$ per
Ending or Current Salary
$ per
Reason for Leaving
Date Separated (mo/yr) List major duties in order of their importance in the job:
Full Time Years Months
Part Time Years Months
If part time, number of hours
worked per week:
Employer: Address:
Job Title: Supervisor’s Name Telephone Number No. Supervised by you:
Date Employed (mo/yr) Starting Salary
$ per
Ending or Current Salary
$ per
Reason for Leaving
Date Separated (mo/yr) List major duties in order of their importance in the job:
Full Time Years Months
Part Time Years Months
If part time, number of hours
worked per week:
I certify that I have given true, accurate and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my
work, I authorize educational institutions, associations, registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I
authorize investigation of all statements made in this application and understand that false information or documentation, or a failure to disclose relevant information may
be grounds for rejection of my application, disciplinary action or dismissal if I am employed, and (or) criminal action. I further understand that dismissal upon employment
shall be mandatory if fraudulent disclosures are given to meet position qualifications (Authority: G.S. 126-30, G.S. 14-122.1.)
Signature of Applicant (unsigned applications will not be processed) Date
____________
Montgomery Community College
1011 Page Street, Troy, North Carolina 27371
A completed MCC application requires three references. The references listed must be readily accessible, and the applicant should
have notified the reference in advance that they may be contacted by the College. References may not be related to the applicant.
Reference #1: a former supervisor or employer
Name:
Title:
Business:
Dates Employed:
Phone
:
Email
Best time to contact:
Reference #2: a former coworker or employer
Name:
Title:
Business:
Dates Employed:
Phone:
Email:
Best time to contact:
Reference #3: a character reference
Name:
Occupation:
Phone:
Email:
Best time to contact:
Applicant Signature Date
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