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Employment Application (Meridian Community College)

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Instructions
We appreciate your interest in working for Meridian Community College. Please respond to all questions
on the application and sign the release, which allows us to contact your current and/or former employer.
Resumes are appreciated and may be attached. If you choose to submit a resume, it does not substitute for
the application and we do require that the application be complete.
Other required documentation
The "Position Announcement" details other information required as a part of the application process. If
"Letters of Reference" are required, please ask your references to submit them prior to the application
deadline and to note the vacancy position and number in their letter. If there are educational requirements
noted on the vacancy position, it is your responsibility to insure that copies of all transcripts are received
by the vacancy deadline. For application purposes, a student copy of Academic Transcript is permissible.
However, if hired, an ofcial copy will be required.
Process
After the closing date, a committee independently reviews all completed applications and selects three
to ve persons to be interviewed. Interviews are then scheduled. The screening and interviewing process
will be completed in a timely fashion. MCC does not release the information regarding the status of
individual applications until the process is complete. All candidates, including those not interviewed, are
notied of the outcome once a decision has been made. Please note; The optional "Statistical Survey" is
kept for statistical purposes only and is not forwarded to the committee members who will be screening
and interviewing.
Responsibilities
If you have a contractual obligation to an employer for the period of employment described in the vacancy
announcement, it is your responsibility to contact your employer regarding your application.
Questions
If you have questions about the information required and/or its receipt by MCC, please contact the Human
Resources Department, 601-581-3508; 601-484-8701 (fax); hr.mcc@meridiancc.edu. The College does
not notify candidates regarding the receipt of materials.
Employment Application
Give a brief description of your understanding of the mission and purpose of the community college
and how your background and experience relate to that understanding.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Do you have contractual obligations to any employer which could conict with your assuming the
position for which you are applying? Yes_____ No_____
If yes, do you understand that it is your responsibility to discuss the contractual implication of your
application with your current employer? Yes_____ No_____
Have you ever been convicted of a felony? Yes_____ No_____
I certify that the foregoing statements are, to the best of my knowledge and belief, true and correct. I
authorize my former employers to release any information they may have regarding me.
______________________________________________
(Signature of Applicant)
910 Highway 19 North • Meridian, MS 39307
www.meridiancc.edu • 1-800-MCC-THE-1
MCC does not discriminate on the basis of race, color, national origin, sex, disability, religion or age in admission or access
to, or treatment or employment in its programs and activities. Compliance with Section 504 is coordinated by Soraya Welden,
dean of student services, 910 Highway 19 North, Meridian, MS 39307. 1-601-484-8707; fax: 1-601-484-8635, email: swelden@
meridiancc.edu. Compliance with Title IX is coordinated by Derek Mosley, social science instructor, Smith Hall, 910 Highway
19 North, Meridian, MS 39307. 601-553-3453, fax: 601-484-8635, email: dmosley@meridiancc.edu
Faculty/Staff
Position Desired: ________________________________________ Vacancy#: _______________
Name: _____________________________________________SSN: ____________________________
(last) (rst) (middle)
Present Address: ______________________________________________________________________
(streetandnumber) (cityandstate) (zip) (phone)
Permanent Address: ___________________________________________________________________
(streetandnumber) (cityandstate) (zip) (phone)
Educational Qualications
High School:
________________________________________ Year Graduated: ___________________
Position: Full Time Part Time
Describe specic courses you have taken which have prepared you especially well for this position.
Please include computer knowledge/experience.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Please list other educational experiences which strengthen your qualications (travel, writing,
workshops, military service).
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Education
School
Name, Address
of School
Course of Study
No of years
completed
Diploma / Degree
Undergraduate
College
Graduate /
Professional
Other
(Specify)
Work Experience
Start with your present or last job.
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Name Occupation
Dates Employed Work Performed
Hourly Rate Salary
May We Contact? Yes No
Dates Employed
Hourly Rate Salary
May We Contact? Yes No
Dates Employed
Hourly Rate Salary
May We Contact? Yes No
Dates Employed
Hourly Rate Salary
May We Contact? Yes No
Comments: Include explanation of any gaps in employment.
Personal Professional References
(do notincludefamilymembers)
Telephone Number Best Time to Call
Work Performed
Work Performed
Work Performed
This data is being collected for statistical purposes only. This information will not be given to the Hiring
Committee and will not be used in connection with the hiring process. We appreciate your assistance in
our data collection.
Position:
__________________________________Vacancy Number: ___________________________
Gender: _____ Male _____ Female
Race : _____ Caucasian _____ African American _____ Native American
_____ Hispanic _____ Asian _____ Other
Age: _____ 18-25 _____ 26-36 _____ 37-45 _____ 46-55 _____ Over 55
Optional
Statistical Survey
Revised September, 2017
Faculty/Staff
Position Desired: ________________________________________ Vacancy#: _______________
Name: _____________________________________________SSN: ____________________________
(last) (rst) (middle)
Present Address: ______________________________________________________________________
(street andnumber) (cityandstate) (zip) (phone)
Permanent Address: ___________________________________________________________________
(street andnumber) (cityandstate) (zip) (phone)
Educational Qualications
High School:
________________________________________ Year Graduated: ___________________
Position: Full Time Part Time
Describe specic courses you have taken which have prepared you especially well for this position.
Please include computer knowledge/experience.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Please list other educational experiences which strengthen your qualications (travel, writing,
workshops, military service).
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Education
School
Name, Address
of School
Course of Study
No of years
completed
Diploma / Degree
Undergraduate
College
Graduate /
Professional
Other
(Specify)
Work Experience
Start with your present or last job.
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Name Occupation
Dates Employed Work Performed
Hourly Rate Salary
May We Contact? Yes No
Dates Employed
Hourly Rate Salary
May We Contact? Yes No
Dates Employed
Hourly Rate Salary
May We Contact? Yes No
Dates Employed
Hourly Rate Salary
May We Contact? Yes No
Comments: Include explanation of any gaps in employment.
Personal Professional References
(donotincludefamilymembers)
Telephone Number Best Time to Call
Work Performed
Work Performed
Work Performed
This data is being collected for statistical purposes only. This information will not be given to the Hiring
Committee and will not be used in connection with the hiring process. We appreciate your assistance in
our data collection.
Position:
__________________________________Vacancy Number: ___________________________
Gender: _____ Male _____ Female
Race : _____ Caucasian _____ African American _____ Native American
_____ Hispanic _____ Asian _____ Other
Age: _____ 18-25 _____ 26-36 _____ 37-45 _____ 46-55 _____ Over 55
Optional
Statistical Survey
Revised September, 2017
Faculty/Staff
Position Desired: ________________________________________ Vacancy#: _______________
Name: _____________________________________________SSN: ____________________________
(last) (rst) (middle)
Present Address: ______________________________________________________________________
(street andnumber) (cityandstate) (zip) (phone)
Permanent Address: ___________________________________________________________________
(street andnumber) (cityandstate) (zip) (phone)
Educational Qualications
High School:
________________________________________ Year Graduated: ___________________
Position: Full Time Part Time
Describe specic courses you have taken which have prepared you especially well for this position.
Please include computer knowledge/experience.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Please list other educational experiences which strengthen your qualications (travel, writing,
workshops, military service).
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Education
School
Name, Address
of School
Course of Study
No of years
completed
Diploma / Degree
Undergraduate
College
Graduate /
Professional
Other
(Specify)
Work Experience
Start with your present or last job.
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Employer
Address From To
Telephone Number(s)
Starting/Present Job Title
Supervisor Starting Final
Reason for Leaving
Name Occupation
Dates Employed Work Performed
Hourly Rate Salary
May We Contact? Yes No
Dates Employed
Hourly Rate Salary
May We Contact? Yes No
Dates Employed
Hourly Rate Salary
May We Contact? Yes No
Dates Employed
Hourly Rate Salary
May We Contact? Yes No
Comments: Include explanation of any gaps in employment.
Personal Professional References
(do notincludefamilymembers)
Telephone Number Best Time to Call
Work Performed
Work Performed
Work Performed
This data is being collected for statistical purposes only. This information will not be given to the Hiring
Committee and will not be used in connection with the hiring process. We appreciate your assistance in
our data collection.
Position:
__________________________________Vacancy Number: ___________________________
Gender: _____ Male _____ Female
Race : _____ Caucasian _____ African American _____ Native American
_____ Hispanic _____ Asian _____ Other
Age: _____ 18-25 _____ 26-36 _____ 37-45 _____ 46-55 _____ Over 55
Optional
Statistical Survey
Revised September, 2017
Instructions
We appreciate your interest in working for Meridian Community College. Please respond to all questions
on the application and sign the release, which allows us to contact your current and/or former employer.
Resumes are appreciated and may be attached. If you choose to submit a resume, it does not substitute for
the application and we do require that the application be complete.
Other required documentation
The "Position Announcement" details other information required as a part of the application process. If
"Letters of Reference" are required, please ask your references to submit them prior to the application
deadline and to note the vacancy position and number in their letter. If there are educational requirements
noted on the vacancy position, it is your responsibility to insure that copies of all transcripts are received
by the vacancy deadline. For application purposes, a student copy of Academic Transcript is permissible.
However, if hired, an ofcial copy will be required.
Process
After the closing date, a committee independently reviews all completed applications and selects three
to ve persons to be interviewed. Interviews are then scheduled. The screening and interviewing process
will be completed in a timely fashion. MCC does not release the information regarding the status of
individual applications until the process is complete. All candidates, including those not interviewed, are
notied of the outcome once a decision has been made. Please note; The optional "Statistical Survey" is
kept for statistical purposes only and is not forwarded to the committee members who will be screening
and interviewing.
Responsibilities
If you have a contractual obligation to an employer for the period of employment described in the vacancy
announcement, it is your responsibility to contact your employer regarding your application.
Questions
If you have questions about the information required and/or its receipt by MCC, please contact the Human
Resources Department, 601-581-3508; 601-484-8701 (fax); hr.mcc@meridiancc.edu. The College does
not notify candidates regarding the receipt of materials.
Employment Application
Give a brief description of your understanding of the mission and purpose of the community college
and how your background and experience relate to that understanding.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Do you have contractual obligations to any employer which could conict with your assuming the
position for which you are applying? Yes_____ No_____
If yes, do you understand that it is your responsibility to discuss the contractual implication of your
application with your current employer? Yes_____ No_____
Have you ever been convicted of a felony? Yes_____ No_____
I certify that the foregoing statements are, to the best of my knowledge and belief, true and correct. I
authorize my former employers to release any information they may have regarding me.
______________________________________________
(Signature of Applicant)
910 Highway 19 North • Meridian, MS 39307
www.meridiancc.edu • 1-800-MCC-THE-1
Meridian Community College does not discriminate on the basis of race, color, national origin, sex, disability,
religion or age in admission or access to, or treatment or employment in its programs and activities. Compliance
with Section 504 is coordinated by Mrs. Deanna Smith, Dean of Student Services, 910 Highway 19 North,
Meridian, MS 39307. 601.484.8895, Fax: 601.484.8635, email: dsmith40@meridiancc.edu. Compliance with Title
IX is coordinated by Mr. Derek Mosley, Social Science Instructor, Smith Hall, 910 Highway 19 North, Meridian, MS
39307. 601.553.3453, Fax: 601.484.8635, email: dmosley@meridiancc.edu.
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Completed 26 July 2020

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