Application Procedure
TheCollege’shiringrepresentativesgivecarefulconsiderationofallapplicationsthataresubmitted.We
recommendthatyoucompletetheemploymentapplicationwithcarefulattentiontodetail,includingthe
“WorkExperience”sectioneventhoughthisinformationmayberepeatedonyourresumé.
Pleaseindicatethecurrentopenpositionforwhichyouareapplyingontheapplication.
Ifyouareapplyingformorethanoneposition,pleaselloutaseparateapplicationforeachposition.
PAGE1
EMPLOYMENT APPLICATION
COLLEGE
MISSION
CORE VALUES
The mission of Richland Community College is to provide innovative educational
environments, opportunities, and experiences that enable individuals, communities,
and the region to grow, thrive, and prosper.
Commitment
|
Respect
|
Excellence
|
Accountability
|
Diversity
Richland Community College is an equal opportunity employer and educator.
Discrimination is prohibited against employees, job applicants, students, and contractors.
PLEASE PRINT OR TYPE ON THE APPLICATION
Date Positionappliedfor o Full-time
o Part-time
Name HaveyoubeenemployedbyRichlandbefore? oYesoNo
Ifyes,givedatesandjobtitle.
Presentaddress
AreyoucurrentlyemployedbyRichland? o YesoNo
City State Zip Ifyes,givedatesandjobtitle.
E-mailAddress Daytimephoneandhoursavailabletobereached.
()
Ifpart-time,indicateavailablehoursforwork. Eveningphoneandhoursavailabletobereached.
()
Whyareyouinterestedinthisposition?
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Wheredidyourstlearnaboutthisjobopening?
o NewspaperAdvertisement(specify)______________________________________________________________
o Internet(specifywebsite)_______________________________________________________________________
o RichlandEmployee o Friend/Relative o Walk-in o Other _____________________________________________
PAGE2
Education and Training 1. Highschoollastattended2.College/technicalschool3.University4.Other
NameofSchool CityandState CourseofStudy Graduated ListtypeofDiplomaorDegree
1. Yeso
Noo
2. Yeso
Noo
3. Yeso
Noo
4. Yeso
Noo
Listacademichonors,awards,scholarships,oractivitiesyouconsidersignicantorrelevanttoemployment.
TitleofyourMaster’sThesisorDoctoralDissertation.
Work Experience (Beginwithyourmostrecentemploymentexperience.)
Employer’s name City/State Description of duties
Position title From (Mo./Yr.) To (Mo./Yr.)
Hours per week Reason for leaving
Supervisor
May we contact this employer now? Telephone number
o Yes o No ( )
Employer’s name City/State Description of duties
Position title From (Mo./Yr.) To (Mo./Yr.)
Hours per week Reason for leaving
Supervisor
Telephone number
( )
Employer’s name City/State Description of duties
Position title From (Mo./Yr.) To (Mo./Yr.)
Hours per week Reason for leaving
Supervisor
Telephone number
( )
Employer’s name City/State Description of duties
Position title From (Mo./Yr.) To (Mo./Yr.)
Hours per week Reason for leaving
Supervisor
Telephone number
( )
(Please continue on a separate sheet of paper if you have other signicant employment.)
May we contact this employer now?
o Yes o No
May we contact this employer now?
o Yes o No
May we contact this employer now?
o Yes o No
PAGE3
Licenses/Certicates
Type YearReceived ExpirationDate
Whatrelevantexperienceshaveyouacquiredthroughemployment,educationandtraining,hobbies,orvolunteer
servicesthatyouwouldliketheCollegetoconsiderinrelationshiptothedesiredposition?
Listanyadditionaltraining,skills,and/orknowledgewhichyoubelievemayenhanceyourqualicationsforemployment.
Listanyprofessionalorganizationstowhichyoubelong.
(You may exclude organizations, the name or character of which indicates race, color, religion, sex, marital or parental status, national origin or
ancestry, age, mental or physical disability, sexual orientation, military status, status as a disabled or Vietnam-Era veteran.)
Listanyarticles,books,orothermaterialsyouhavepublished.
(ForAcademicapplicantsonly)
Haveyoueverbeenamemberofthearmedforces?
o
Yes
o
No
Ifso,doesyourmilitaryexperiencehaveanyrelationshiptothepositionforwhichyouareapplying?Pleaseexplain.
AreyouauthorizedtoworkintheUnitedStates?
o
Yes
o
No
(You must be able to prove that you are legally employable by completing INS Form I-9 and providing documents verifying your identity within three
days of accepting an offer of employment or within three days of the time employment actually commences.)
Employment References
List three (3) people who have had direct contact with your professional work. (e.g., supervisor, department chairperson, co-worker, professor.)
Name Address(Homeand/ore-mail) DaytimeTelephone Occupation
Statement of Annuity Status for the State University Retirement System
Illinois universities and colleges are required to determine and report the State University Retirement System retirement status of
all employees. Please provide the following information in regards to your State University Retirement System (SURS) status.
IhavereceivedoramcurrentlyreceivingaretirementannuityfromtheStateUniversityRetirementSystem.................. o YesoNo
IhavereceivedoramcurrentlyreceivingaretirementannuityfromtheStateUniversityRetirementSystem,
andamcurrentlyemployedbyanotherSURScoveredemployer.................................................... o YesoNo
IherebypledgethatifIattainemploymentwithRichlandCommunityCollegeandbeginreceivingaStateUniversity
RetirementSystembenet,IwillnotifytheCollegeinwritingwithin14daysofmychangeinretirementstatus................ o YesoNo
IherebypledgethatifIattainemploymentwithRichlandCommunityCollegeandacceptadditionalemploymentwith
anotherSURScoveredemployerwhilereceivingaStateUniversityRetirementSystemannuity,IwillnotifytheCollege
inwritingwithin14daysofacceptingthenewemployment........................................................ o YesoNo
Iunderstandthatmyfailuretocomplywiththepreviousnoticationrequirementsmayresultinterminationofmyemployment.... o YesoNo
Employment Application for Richland Community College
Please Read Carefully
Icertifythattheinformationonthisapplicationistrueandcomplete.Iunderstandthatfalseinformation
orstatementsprovidedonthisapplicationshallbeconsideredsufcientcausefordisqualicationof
considerationordismissalfromemployment.
IauthorizeRichlandCommunityCollegetocontactpreviousemployersandsupervisorsandtomakeany
investigationnecessarytoverifytheinformationappearingonthisapplication,aswellasaninvestigationof
mycharacter,reputation,andanyinformationpertinenttomyemploymentqualications.
Ialsounderstandthatnothinginthisemploymentapplicationisintendedtobeorshouldbeconstruedtobea
promiseofemploymentortodeneanyspecicperiodregardingemployment.Ialsounderstandthatifhired,
myemploymentatRichlandCommunityCollegeisstrictlyan“atwill”employmentrelationship,andthatany
changesinthe“atwill”relationshipcanbeaffectedonlybywrittenagreementsignedbythePresidentofthe
College.ThismeansthatyouortheCollegecanterminateyouremploymentatanytimeandforanyreasonor
noreason.
Tovalidatethisapplication,theapplicantmustsignonthelinesodesignated.Ifyouaresubmittingthisform
electronically,pleaseleavethisdateandsignaturelineblank.Yoursignaturepertainingtotheunderstandings
listedabovewillberequiredifyourapplicationproceedstothenextstepoftheprocess.
Date ________________ Signature of Applicant __________________________________
Human Resources Department, Richland Community College
One College Park | Decatur, IL 62521 | 217.875.7211, Ext. 6
218 | hr@richland.edu
PLEASE RETURN COMPLETED APPLICATION TO:
PAGE4
STATISTICSANDSECURITYMEASURESPursuant to the Jean Cleary Security Act, Richland Community College provides
information relating to crime statistics and security measures for current and potential students and employees. For more information, as well
as a printed copy of the College’s crime statistics, please contact the Campus Security Ofce or Student Success Ofce at 217.875.7200.
R.09.2019
click to sign
signature
click to edit
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