EMPLOYMENT APPLICATION
To be considered for employment, you are required to complete an application form. The offer of employment is contingent upon the ability to provide documentation
which demonstrates employment eligibility required by the Immigration Reform and Control Act of 1986. All new employees will be required to complete an
“Employment Eligibility Verification” (Form I-9) and produce requested documentation after employment. *Federal law requires Pratt Community College to hire only
United States citizens and aliens authorized to work in the United States.
Please answer completely and sign the application form.
PERSONAL INFORMATION POSITION INFORMATION
Full Name_________________________________________ Application Date________________________________
Address ___________________________________________ Position of Interest______________________________
City, State, Zip Code_________________________________ Fu
ll-time/Part-time______________________________
Phon
e____________________________________________ Date Available__________________________________
Email_____________________________________________ Anticipated Salary_______________________________
Are you 18 years of age or older? ⃝ YES ⃝ NO
Are you willing to relocate? YES ⃝ NO
Can you legally work in the United States and, if hired, show proof of eligibility? YES ⃝ NO
Have you previously been employed by Pratt Community College? YES ⃝ NO
If yes, provide the dates, positions held, and reason for leaving.
__________________________________________________________________________________________________
Have you ever been convicted of a crime other than a minor traffic citation? YES ⃝ NO
If yes, provide the date and disposition. A conviction will not automatically bar you from employment.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Are there other names under which employment and/or academic records have been filed?
__________________________________________________________________________________________________
REFERENCES
List at least 3 persons who have knowledge of your work experience and/or education.
(Do not include relatives, personal friends or immediate supervisors listed in the employment section.)
NAME TITLE ADDRESS PHONE
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Personnel Office
(620) 450-2226 or (620) 450-2139, fax (620) 450-2285
348 NE SR 61 Pratt, Kansas 67124
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EDUCATION
Provide complete information for current and past education. Begin with present or most recent college education.
Attach additional education history if necessary.
High School/GED College 1 College 2 College 3
Name
City/State
From
To
Graduate?
YES ⃝ NO YES ⃝ NO YES ⃝ NO YES ⃝ NO
Degree
Major/Minor
TEACHING EXPERIENCE (for academic professionals only)
Community College Full Time ⃝ Part Time ⃝ N/A
Four-year College or University Full Time ⃝ Part Time ⃝ N/A
High School or Elementary Full Time ⃝ Part Time ⃝ N/A
Other educational setting Full Time ⃝ Part Time ⃝ N/A
If applying for a teaching position, you must
provide copies of transcripts/credentials with application.
OTHER TRAINING/CERTIFICATIONS/SKILLS
Other Specialized or Technical Training Not Listed Above.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
License, Certifications and Registrations Not Listed Above.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Other skills, abilities or qualifications relevant to this job. Include equipment and software you can operate.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
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EMPLOYMENT HISTORY
Provide complete information for all current and past employment. Begin with present or most recent employment.
Attach additional employment history if necessary.
Company Name________________________________
Address_______________________________________
Phone________________________________________
Supervisor_____________________________________
Position Held___________________________________
Starting Salary__________________________________
Final Salary____________________________________
May we contact this employer for reference? ⃝ YES ⃝ NO
If no, explain____________________________________
Company Name________________________________
Address_______________________________________
Phone________________________________________
Supervisor_____________________________________
Position Held___________________________________
Starting Salary__________________________________
Final Salary____________________________________
May we contact this employer for reference? ⃝ YES ⃝ NO
If no, explain____________________________________
Company Name________________________________
Address_______________________________________
Phone________________________________________
Supervisor_____________________________________
Position Held___________________________________
Starting Salary__________________________________
Final Salary____________________________________
May we contact this employer for reference? ⃝ YES ⃝ NO
If no, explain____________________________________
From_________________________________________
To___________________________________________
Duties________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Reason for Leaving______________________________
_____________________________________________
From_________________________________________
To___________________________________________
Duties________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Reason for Leaving______________________________
_____________________________________________
From_________________________________________
To___________________________________________
Duties________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Reason for Leaving______________________________
_____________________________________________
Please
explain any breaks or periods of unemployment in your employment history:
From_____________ To _____________ Reason ________________________________________________________
From_____________ To _____________ Reason ________________________________________________________
From_____________ To _____________ Reason ________________________________________________________
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3 of 5
Pratt Community College prides itself on having a student-centered learning environment. This requires that all
employees be focused on providing student-centered instruction and services.
PCC’s student centered philosophy is: “The student is our customer; he/she deserves our full time and attention”.
As a candidate for employment at PCC....
How do you visualize the position for which you are applying fitting into our student-centered employment
philosophy?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
If you are employed at PCC, what will you do to be student-centered in your job performance?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
At PCC, we view our co-workers, i.e., all college employees, as our “internal customers” who deserve our attention
and friendly cooperation. Teamwork is a high priority. Briefly explain how and why you would fit into this type of
work environment.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
DISCLAIMER AND SIGNATURE
It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this
application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free
to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause. I understand
that no representative of the employer has the authority to make any assurances to the contrary.
I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby
release from liability the employer and its representatives for seeking such information and all other persons, corporations, or
organizations for furnishing such information.
I have read, or have had read to me, the above statements. By my signature, I understand and agree to these provisions.
Signature_________________________________________________________Date_____________________________
Pratt Community College is an equal opportunity employer and does not discriminate on the basis of race, color, national origin, sex, disability,
age or veteran status in its programs and activities. Pratt Community College hires only U.S. citizens and aliens lawfully authorized to work in the
United States. If you have any questions, please contact the Director of Personnel, Pratt Community College, 348 NE SR 61, Pratt, KS 67124,
620.672.5641 ext. 139, Title IX/Section 504 Coordinator.
Page 4 of 5
PRATT COMMUNITY COLLEGE
EQUAL EMPLOYMENT OPPORTUNITY COMMISSION
INFORMATION FORM
Pratt Community College is an Equal Opportunity Employer and does not discriminate on the basis of any characteristic protected by
Federal, state, or local law.
In an effort to comply with the requirements regarding government record keeping, reporting, and other legal
obligations, we ask that you complete the information below and return it with your application to the Pratt Community
College Personnel Director.
Submittal of this information is completely voluntary and will be held strictly confidential. The data provided here is NOT
a part of the official application for employment and will not affect your opportunity for employment, or terms or
conditions of employment, if hired.
We appreciate your cooperation.
Position applying for ___________________________________________________________
Check one: □ Male □ Female Age: __________
Check one of the following Race/Ethnic Groups:
□ Caucasian
□ American Indian/Alaskan Native
□ Black or African American
□ Asian
□ Hispanic or Latino
□ Other
Check if any of the following are applicable
:
□ Disabled Individual
□ Disabled Veteran
□ Vietnam Era Veteran
□ Special Disabled Veteran
□ Other Veteran
Referral Source (please identify source):
□ Advertisement in Publication ___________________________________
□ Employee Name of Publication
□ Relative
□ PCC Website
□ Other website ________________________________________________
Date completed __________________________________
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