EMPLOYMENT APPLICATION
BOX 12257
S
EARCY, AR 72149-2257
hr@harding.edu
(Federal law recognizes the right of church-related institutions to seek personnel who will support the goals of the
institution, including the right to select members of the church to which the institution is related.)
Please complete the application in black or blue ink.
Date ___________________________
Nam
e __________________________________________________ Social Security No. ______________
Street Address ___________________________________________ E-mail Address
________________
City ________________________ Co. _______________________ State ______ ZIP Code __________
Home Phone ______________________________ Work/Message Phone ___________________________
Are you a member of the church of Christ?
Yes No
What is the name of your place of worship?
____________________________________________________
City _______________________ Co. _______________ State _____ Zip Code _____________________
Name of one of the elders/ministers ___________________________________ Phone
______________
Employment Data
Position applied for _________________________________ Date available __________________________
What is your availability for work? Full-time Part-time Temporary
Have you been employed with Harding before?
Yes No
If yes, please complete the following:
Location(s) ___________________________________________________________________________
Dates Employed ______________________________________________________________________
Reason for Leaving
_
Are you related (by blood or marriage) to anyone now working at Harding? Yes No
If yes, please identify the person(s) and how you are related _____________________________________
If hired, can you provide documentation of eligibility evidence (I-9 Form) to work in the United States within the
first three business days of employment?
Yes No
Have you ever been convicted of a crime?
Yes No
If yes, describe briefly, including date(s). (Conviction will not necessarily disqualify you from employment.
________________________________________________________________________________________
________________________________________________________________________________________
Name of probation officer
________________________________________________________________
- Harding University, An Equal Opportunity Employer -
For Office Use Only
Résumé
__ Letter __
G__
M__ S__T__
Wi__ Wo__ DE__
Other__________
Educational Data
Name and Address of School Major
Did You
Graduate?
Degree or Certificate Received
High School/GED _____________
____________________________
College _____________________
____________________________
Grad School _________________
____________________________
Other School(s) ______________
____________________________
____
________________________
_____________
_____________
___________
Yes No
Yes No
Yes No
Yes No
_________________________
_________________________
_________________________
_________________________
_________________________
Office Machines and Office Skills
Designate office equipment you have operated and indicate number of years of experience with each.
______ Which type? _______ Ten-key Calculator Years _______ By touch ________
Personal computer Years
______ Speed (wpm) _______ Other software ____________________________________________ Word processor Years
______ Excel Years _____ PowerPoint Years ____ Other equipment ___________________________________________
Word Years
Indicate below other relevant experiences, skills, and qualifications (i.e., word processing/computer software and/or languages).
________________________________________________________________________________
________________________________________________________________________________
Work History: If there are more employers than space provided for, please indicate them on an attached sheet.
Current Employer Information
Employer ________________________________________ Date Employed ________________________________
Address _________________________________________ Beginning Salary___________ Current _____________
City
Co. State ______ ZIP Code Phone __________________
Job Title _________________________________________ Supervisor _________________________________
Work Performed __________________________________________________________________________________
May we contact your current employer?
Yes No
If “No”, please state reason. _________________________________________________________________________
_________________________________________________________________________________________________
Previous Employers
1. Employer ______________________________________ Date Employed From To ________________
Address _________________________________________ Beginning Salary
Ending Salary __________
City
Co. State _______ ZIP Code Phone _____________________
Job Title ________________________________________ Supervisor _____________________________________
Work Performed ___________________________________________________________________________________
Departure
Voluntary Involuntary (Please provide an explanation for either category.)
Reason __________________________________________________________________________________________
2. Employer ______________________________________ Date Employed From
To ________________
Address _________________________________________ Beginning Salary
Ending Salary __________
City
Co. State _______ ZIP Code Phone _____________________
Job Title ________________________________________ Supervisor _____________________________________
Work Performed ___________________________________________________________________________________
Departure
Voluntary Involuntary (Please provide an explanation for either category.)
Reason __________________________________________________________________________________________
3. Employer ______________________________________ Date Employed From
To ________________
Address _________________________________________ Beginning Salary
Ending Salary __________
City
Co. State _______ ZIP Code Phone _____________________
Job Title ________________________________________ Supervisor _____________________________________
Work Performed ___________________________________________________________________________________
Departure
Voluntary Involuntary (Please provide an explanation for either category.)
Reason __________________________________________________________________________________________
4. Employer ______________________________________ Date Employed From
To ________________
Address _________________________________________ Beginning Salary
Ending Salary __________
City
Co. State _______ ZIP Code Phone _____________________
Job Title ________________________________________ Supervisor _____________________________________
Work Performed ___________________________________________________________________________________
Departure
Voluntary Involuntary (Please provide an explanation for either category.)
Reason __________________________________________________________________________________________
5. Employer ______________________________________ Date Employed From
To ________________
Address _________________________________________ Beginning Salary
Ending Salary __________
City
Co. State _______ ZIP Code Phone _____________________
Job Title ________________________________________ Supervisor _____________________________________
Work Performed ___________________________________________________________________________________
Departure
Voluntary Involuntary (Please provide an explanation for either category.)
Reason __________________________________________________________________________________________
Authorization for Reference
For each employer previously named in this application, except my current employer if so limited on this application, I
authorize Harding University to obtain from such employer work-related information regarding my qualifications and
fitness for all Harding jobs for which I might be considered. I also authorize Harding University to inquire into all
statements I have made on this application. I understand and agree that my failure to identify any employer(s) may result
in this application not being considered. I authorize Harding University to request character references from the
congregation I attend.
Employment is At Will
I also understand that, if employed, I can resign at any time and for any reason and that Harding University may release
me at any time and for any reason or no reason.
Employee Handbook
I recognize that, if employed, I am obligated to abide by and am subject to all rules, terms, conditions, and regulations of
the Harding University Employee Handbook, as amended from time to time.
Verification of Identity and Work Authorization
I understand that an offer of employment is contingent upon my completing the Homeland Security Employment Eligibility
Verification (Form I-9) and providing documents to verify my identity and employment eligibility as required by law on the
first day of work. When completing the Form I-9, I understand I will be required to attest that I am a citizen or national of
the United States, a lawful permanent resident, or an alien authorized to work. All new employees will be required to
produce documentation.
Statements in this Application are True
I attest that all statements made on this application are true and correct. I understand that false statements made
intentionally on this form or any of my other application materials would eliminate me from further consideration for
employment or, if employed by Harding University, would be grounds for my dismissal.
________________________________________________________ _______________________________________
Applicant’s Signature Date Signed
For your application to be considered, check the following boxes:
I have completed the application.
I have signed the application.
I have signed the Authorization to Release Reference Information form.
I have signed the Employment Reference form.
Employment Reference With Consent and Release*
Applicant: Please complete only through your signature. Do NOT send this to your employer(s).
A reference will be requested from your employer(s) by Human Resources or the hiring supervisor.
___ , (Print Name of Applicant) SSN: ______ __I,
hereby give consent to all of my prior employers, and my current employer if authorized, to provide Harding
University the information below with regard to my employment with the prior or current employers. This consent
is valid for a period of six (6) months from the date indicated below. A copy of this form shall serve as an original.
Signature of Applicant:
Date: _____________________
*****The following is to be completed by the current or former employer.*****
Instructions: The individual named above has applied for employment with Harding University. Please
respond candidly to the requests for information listed below and return your written responses via either
facsimile or U.S. Mail. This Employment Reference With Consent and Release is intended to comply with
Arkansas Act 1474 of 1999, an Act to provide current and former business employers with protection for
providing job information about current or former employees to prospective employers.
_______________________________________ ______________________________________________
Previous or Current Employer Address
______________________________________, _____________________________ ________________
City State ZIP Code
Phone: ( ) Fax: ( ) _____________________________
Completed by: __________________________ _ _________________________________________
Signature Date Print Name
Job Information:
Is the applicant eligible for rehire? _____Yes _____No _____Conditional (attach explanation)
Date and duration of employment:_____________________________________________________________
Current or last rate of pay and wage history:_____________________________________________________
Current or last job description and duties: ______________________________________________________
_______________________________________________________________________________________
_
The details of the applicants last written performance evaluation prepared prior to the date the applicant
signed this consent (see date above): _________________________________________________________
_______________________________________________________________________________________
Attendance history (excluding any qualifying leave under FMLA): ____________________________________
Results of drug and/or alcohol tests administered within the last year: ________________________________
________________________________________________________________________________________
Details of any threats of violence, harassing acts, or threatening behavior related in any way to the workplace
or directed at another employee: _____________________________________________________________
_______________________________________________________________________________________
Was his/her separation from employment _____ voluntary _____ involuntary?
What was the reason for the applicant’s separation from employment? _______________________________
________________________________________________________________________________________
Please Return to:
Office of Human Resources
Harding University, Box 12257, Searcy, AR 72149-2257
Phone: 501-279-4380 Fax: 501-279-4773
Authorization to Release Reference Information
*Reference Not Valid Unless Sent by the Office of Human Resources
Applicant: Please complete only through your signature.
A reference will be requested once employment is obtained.
I, __ (Print Name of Applicant),
hereby give consent to any Elder, Deacon, Minister or Ministry Leader to provide the information
below with regard to my membership at
____ _ located in
(Print Name of Congregation)
, ______ _______ _____________ ___________________
(Print Name of City) (State) (ZIP) (Phone) (Fax)
I release and indemnify the person giving this recommendation (along with the stated
congregation) from all liabilities, claims and actions that may arise from the recommendation given, a
disclosure from this authorization, and any consequences to a disclosure.
This consent is valid for a period of six (6) months from the date indicated below. A copy of
this form shall serve as an original.
Signature of Applicant: Date: ________________________
(This portion to be completed by an Elder, Deacon, Minister or Ministry Leader.)
The above mentioned person is in good standing with the ________________________ church of
Christ and I would recommend this individual to help Harding in accomplishing her mission.
Yes No Not known well enough to reply Not on membership roll
Signature: ______________________________________________ Date: __________________
Minister Elder Deacon Ministry Leader
Please Return to:
Office of Human Resources
Harding University, Box 12257, Searcy, AR 72149-2257
Phone: 501-279-4380 Fax: 501-279-4773
Harding University is a Christian university of higher education. The purpose of the University is to give students
an education of high quality that will lead to an understanding and philosophy of life consistent with Christian
ideals. This is accomplished, in part, by having employees of the highest moral and ethical character.
Pre-Employment Inquiry Release
In connection with, and for the duration of, my employment (including contract for services) with you, I understand
that investigative background inquires are to be made on myself including consumer, criminal, driving, and other
reports. This information will, in whole or in part, be obtained from Acxiom Information Security Services (AISS),
6111 Oak Tree Blvd, 4
th
floor, Independence, OH 44131, telephone 800.853.3228. These reports will include
information as to my general reputation, character, mode of living, work habits, performance and experience along with
reasons for termination of past employment from previous employers. Further, I understand that you will be requesting
information from various federal, state and other agencies which maintain public and non-public records concerning
my past activities relating to my driving, credit, civil, education and other experiences.
I authorize, without reservation, any party or agency contacted by this employer to furnish the above mentioned
information:
________________________________________________ ______/______/________ ________-______-________
Applicant Name Date of Birth* Social Security Number
________________________________________________________________________________________________
Alias/Maiden Name (s)
________________________________________________ ____________________________ _________________
Current Address City & State Zip Code
__________________________________ _____________ ______________________________________________
Driver’s License # State Prospective Employer
Applicant’s Signature_____________________________________________ Date ____________________________
*Date of Birth is being requested in order to obtain accurate retrieval of records.
_____ California, Minnesota & Oklahoma Applicants Only: Please check here to have a copy of your consumer
report sent directly to you. Minnesota and Oklahoma applicants will receive a copy direct from AISS.
California applicants may receive a copy from either the prospective employer or AISS.
Notice to California Applicants
Under Section 1786.22 of the California Civil Code, you have the right to request from AISS, upon proper
identification, the nature and substance of all information in its files on you, including the sources of information, and
the recipients of any reports on you which AISS has previously furnished within the two-year period preceding your
request. You may view the file maintained on you by AISS during normal business hours. You may also obtain a copy
of this file upon submitting proper identification and paying the costs of duplication services. Upon making a written
request, you may receive a summary of your report via telephone.
Applicant Data Record
For Office Use Only
Social Security Number
Date of Application
Name (Last) (First) (MI)
Position Applied
Address
Campus
City
Department
State ZIP Code
VP Code
Home Phone ( )
EEOC
Business Phone ( )
Disposition
Message Phone ( )
How did you learn of employment at Harding? (Check the appropriate line or lines.)
Department of Workforce Services Campus posting
Harding website Alumni List
Referral by Harding employee Referral by Harding student
Reputation or knowledge of Harding I am a current or former Harding student
Other (please specify)
Survey Information for Statistical Purposes Only
The following information is needed in order for Harding University to provide the required information upon request by the
EEOC. We strongly encourage all individuals to answer both questions. Completion of this form will not preclude, enhance, or
detract from your opportunities for advancement at Harding University. This data is for Personnel records only. All information
will be confidential and will not be made available to those making employment decisions in your case
Please respond to both questions.
1. Are you Hispanic or Latino? (This includes anyone of Spanish culture or origin.)
Yes
No
2. Select one or more of the following racial groups that apply to you.
American Indian or Alaska Native (A person having origins in any of the original peoples of North and South
America (including Central America), and who maintains a tribal affiliation or community attachment.)
Asian (
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.)
Black or African American (A person having origins in any of the black racial groups of Africa.)
Native Hawaiian or other Pacific Islander
(A person having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.)
White (A person having origins in any of the original peoples of Europe, the Middle East or North Africa.)
Signature: Print Name:
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