Fillable EMPLOYMENT APPLICATION (Tuskegee University)

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EMPLOYMENT APPLICATION (Tuskegee University)

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Country of origin: US
File type: PDF

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TUSKEGEE UNIVERSITY
FOUNDED BY BOOKER T. WASHINGTON
EMPLOYMENT APPLICATION
TUSKEGEE UNIVERSITY IS AN EQUAL OPPORTUNITY EMPLOYER. NO PERSON SHALL BE DENIED EMPLOYMENT ON THE BASIS OF ANY LEGALLY
PROHIBITED DISCRIMINATION INCLUDING, BUT NOT LIMITED TO, SUCH FACTORS AS RACE, COLOR, CREED, RELIGION, NATIONAL OR ETHNIC ORIGIN, SEX,
AGE, OR DISABILITY.
*** THIS APPLICATION DOES NOT GUARANTEE EMPLOYMENT. NO APPLICANT SHOULD BEGIN WORK WITHOUT A CONTRACT SIGNED BY
ALL APPROPRIATE PERSONS, INCLUDING THE PRESIDENT AND THE EMPLOYEE.
*** APPLICATIONS WILL BE ACCEPTED FOR POSTED POSITIONS ONLY.
*** ONLY COMPLETE APPLICATIONS PACKETS ARE ACCEPTED. APPLICATION PACKETS ARE CONSIDERED COMPLETE UPON THE
SUBMISSION OF ALL MATERIALS LISTED IN THE POSITION ANNOUNCEMENTS.
*** APPLICATIONS CAN BE MAILED TO: TUSKEGEE UNIVERSITY, OFFICE OF HUMAN RESOURCES MANAGEMENT,
1200 WEST MONTGOMERY ROAD, KRESGE CENTER SUITE 101, TUSKEGEE, ALABAMA 36088. (PHONE): 334-727-8510
OR FAXED TO
: (FAX): 334-724-4319
OR EMAILED TO
: employment@tuskegee.edu
*** EMPLOYMENT AT TUSKEGEE UNIVERSITY IS ON AN AT WILL BASIS. THEREFORE, EITHER PARTY MAY TERMINATE EMPLOYMENT AT
ANY TIME.
PERSONAL DATE
LAST NAME FIRST MIDDLE SOCIAL SECURITY #
XXX
-
XX
-
STREET ADDRESS HOME TELEPHONE
( )
CITY, STATE, ZIP BUSINESS TELEPHONE
( )
POSITION DESIRED
SALARY EXPECTED
HAVE YOU EVER WORKED FOR
THIS
INSTITUTION?
YES
NO
IF YES, INDICATE: DATES OF EMPLOYMENT DEPARTMENT POSITION
DO YOU HAVE A FAMILY
MEMBER WORKING FOR THE
UNIVERSITY?
YES
NO
IF YES, STATE NAME, RELATIONSHIP AND DEPARTMENT WHERE EMPLOYED:
HAVE YOU BEEN CONVICTED
OF A FELONY or
Misdemeanor? YES
NO
IF YES, PLEASE EXPLAIN
ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE U.S.? YES
NO
EDUCATION
SCHOOL NAME LOCATION DATES ATTENDED COURSE OF STUDY DID YOU GRADUATE? DEGREE OR DIPLOMA
HIGH
SCHOOL
XX/XX/XX
YES NO
COLLEGE
UNIVERSITY
OR
TECHNICAL

YES NO
COLLEGE
UNIVERSITY
OR
TECHNICAL

YES NO
COLLEGE
UNIVERSITY
OR
TECHNICAL

YES NO
LIST HONORS, AWARDS, SKILLS, OR TRAINING THAT MIGHT BE RELEVANT TO EMPLOYMENT:
EMPLOYMENT
EMPLOYER TELEPHONE
ADDRESS BEGINNING DATE: ENDING DATE:
NAME OF SUPERVISOR BEGINNING
SALARY
ENDING SALARY
STATE JOB TITLE AND DESCRIBE WORK REASON FOR LEAVING
EMPLOYER TELEPHONE
ADDRESS BEGINNING DATE: ENDING DATE:
NAME OF SUPERVISOR BEGINNING
SALARY
ENDING SALARY
STATE JOB TITLE AND DESCRIBE WORK REASON FOR LEAVING
EMPLOYER TELEPHONE
ADDRESS BEGINNING DATE: ENDING DATE:
NAME OF SUPERVISOR BEGINNING
SALARY
ENDING SALARY
STATE JOB TITLE AND DESCRIBE WORK REASON FOR LEAVING
EMPLOYER TELEPHONE
ADDRESS BEGINNING DATE: ENDING DATE:
NAME OF SUPERVISOR BEGINNING
SALARY
ENDING SALARY
STATE JOB TITLE AND DESCRIBE WORK REASON FOR LEAVING
REFERENCES
{LIST THREE PERSONS, OTHER THAN RELATIVES OR PERSONAL FRIENDS, WHO HAVE KNOWLEDGE OF YOUR WORK EXPERIENCE OR EDUCATION}
NAME
ADDRESS
PHONE




RELEASE AUTHORIZING CHECK OF APPLICANT’S CREDENTIALS
I HEREBY AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I CERTIFY THAT ALL STATEMENTS
SUBMITTED ARE TRUE, AND UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IN THIS FORM IS CAUSE
FOR TERMINATION OF EMPLOYMENT W ITHOUT NOTICE.
IN CONSIDERATION OF TUSKEGEE UNIVERSITY’S EVALUATION OF MY SUITABILITY FOR EMPLOYMENT, I HEREBY AUTHORIZE THE
UNIVERSITY TO PERFORM ALL CHECKS OF MY CREDENTIALS AS ALLOW ED BY LAW INCLUDING, BUT NOT LIMITED TO, DISCUSSIONS
W ITH SUPERVISORS, CO-W ORKERS, FRIENDS, BUSINESS ASSOCIATES, OR OTHER INDIVIDUALS THAT THE UNIVERSITY, IN ITS SOLE
DISCRETION, BELIEVES MAY HAVE RELEVANT INFORMATION REGARDING MY SUITABILITY FOR EMPLOYMENT.
I RELEASE AND FOREVER DISCHARGE THE UNIVERSITY, ITS AGENTS, ITS EMPLOYEES, AND THE INDIVIDUALS AND COMPANIES
CONTACTED BY THE UNIVERSITY AS PART OF ITS INVESTIGATION, FROM ANY KIND OF ACTION W HATSOEVER ARISING FROM THE
UNIVERSITY’S INVESTIGATION OF MY CREDENTIALS. I ACKNOW LEDGE THAT THE UNIVERSITY HAS MADE NO REPRESENTATIONS OF
ANY KIND AS TO W HETHER EMPLOYMENT WILL BE OFFERED AT THE CONCLUSION OF ITS INVESTIGATION. I FURTHER ACKNOW LEDGE
THAT IF EMPLOYED, I UNDERSTAND AND AGREE THAT SUCH EMPLOYMENT MAY BE TERMINATED AT ANY TIME BY THE UNIVERSITY OR
MYSELF, W ITHOUT ANY LIABILITY TO THE UNIVERSITY FOR ANY CONTINUATION OF SALARY, W AGES, OR EMPLOYMENT RELATED
BENEFITS, OTHER THAN THOSE PRESCRIBED BY APPLICABLE LAWS.
Applicant Signature:
Date:
DISCLOSURE REGARDING BACKGROUND
INVES
TIG
ATION
Tuskegee University may obtain information about you from a third party consumer reporting agency for
employment purposes. Thus, you may be the subject of a “consumer report” and/or an “investigative
consumer report” which may include information about your character, general reputation, personal
characteristics, and/or mode of living, and which can involve personal interviews with sources such as your
neighbors, friends, or associates. These reports may contain information regarding your credit history,
criminal history, social security verification, motor vehicle records (“driving records”), verification of your
education or employment history, worker’s compensation records where permitted by law (post offer), or
other background checks. Credit history will only be requested where such information is substantially
related to the duties and responsibilities of the position for which you are applying.
You have the right, upon written request made within a reasonable time, to request whether a consumer
report has been run about you and disclosure of the nature and scope of any investigative consumer report
and to request a copy of your report. Please be advised that the nature and scope of the most common form
of investigative consumer report obtained with regard to applicants for employment is an investigation into
your education and/or employment history conducted by First Choice Background Screening
Compliance Department, 6365 Taft Street, Suite #2000, Hollywood, FL 33024,Toll-free number: 888-222-
6988 x7808, Toll-free fax: 888-949-2010, www.firstchoicebackground.com. The scope of this notice and
authorization is all-encompassing, however, allowing the Company to obtain from any outside organization
all manner of consumer reports throughout the course of your employment to the extent permitted by law.
ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK
I acknowledge receipt of the document DISCLOSURE REGARDING BACKGROUND INVESTIGATION
(included above) and of the separate document entitled A SUMMARY OF YOUR RIGHTS UNDER THE
FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I
hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the
Employer at any time after receipt of this authorization and throughout my employment, if applicable. To
this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal
agency, institution, school or university (public or private), information service bureau, employer, or
insurance company to furnish any and all background information requested by First Choice Background
Screening, 6365 Taft Street, Suite #2000, Hollywood, FL 33024, Toll-free number: 888-222-6988 x7808,
Toll-free fax: 888-949-2010, www.firstchoicebackground.com and/or Employer itself, acting as my
representative. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be
as valid as the original.
BACKGROUND INFORMATION
Last Name Suffix: ___ First
Middle
Other Names/Alias *SSN#
*Date of Birth Driver’s License # *State
Present Address City/State/Zip
Phone Number Email Address
*This information will be used for background screening purposes only and will not be used as hiring criteria.
Signature Date
***SIGNATURES ARE REQUIRED ON BOTH FORMS***
***DIGITAL SIGNATURES ARE NOT PERMITTED***
New
Y
o
r
k applicants only: Upon request, you will
be informed whether
or not
a consumer report was requested by
the Company, and if such report was requested, informed of the name and address of the consumer reporting
agency that furnished the report. You have the right to inspect and receive a copy of any investigative consumer
report requested by the Company by contacting the consumer reporting agency identified above directly. By signing
below, you acknowledge receipt of Article 23-A of the New York Correction Law
Washington State applican
t
s only: You also
ha
v
e the right to request from the
consumer reporting agency
a
written summary of your rights and remedies under the Washington Fair Credit Reporting Act.
Minnesota and Oklahoma applicants only:
Please check
t
his
box
if you would
like to receive a copy of a
consumer report if one is obtained by the Company. ☐
Califo
r
nia applican
t
s only:
Under California
Civil
Code
section 1786.22, you
are entitled
to
f
ind out what
is
in the
CRA’s file on you with proper identification, as follows:
• In person, by visual inspection of your file during normal business hours and on reasonable notice. You
also may request a copy of the information in person. The CRA may not charge you more than the actual
copying costs for providing you with a copy of your file.
• A summary of all information contained in the CRA file on you that is required to be provided by the
California Civil Code will be provided to you via telephone, if you have made a written request, with proper
identification, for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or
charged directly to you.
• By requesting a copy be sent to a specified addressee by certified mail. CRAs complying with requests for
certified mailings shall not be liable for disclosures to third parties caused by mishandling of mail after such
mailings leave the CRAs.
“Proper Identification” includes documents such as a valid driver’s license, social security account number, military
identification card, and credit cards. Only if you cannot identify yourself with such information may the CRA require
additional information concerning your employment and personal or family history in order to verify your identity. The
CRA will provide trained personnel to explain any information furnished to you and will provide a written explanation
of any coded information contained in files maintained on you. This written explanation will be provided whenever a
file is provided to you for visual inspection. You may be accompanied by one other person of your choosing, who
must furnish reasonable identification. A CRA may require you to furnish a written statement granting permission to
the CRA to discuss your file in such person’s presence.
Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit
report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under
California law. ☐
_
 Signature____________________________________
 Date
_____________________________

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Completed 28 December 2021

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