IOWA LAKES COMMUNITY COLLEGE
E M P L O Y M E N T A P P L I C A T I O N
Iowa Lakes Community College is located in the northwest corner of Iowa with campuses/centers in Estherville,
Emmetsburg, Algona, Spencer and Spirit Lake. The College offers liberal arts/college transfer degrees, technical
training or vocational diplomas and extensive continuing education offerings. The mission of the College is to
provide opportunities for quality lifelong learning and promote economic development for its communities.
Last Name First Name Middle Initial
Number and Street Address City State Zip Code
Telephone Number: Home Cell/Mobile
POSITION FOR WHICH YOU ARE APPLYING:
Date Available
From what source did you hear about this vacancy?
PLEASE NOTE….
The information you provide on this application will be used to evaluate your qualifications. Please be accurate and as specific as possible.
Insufficient information may result in the elimination of your application from further consideration. A resume may be submitted in addition to
but not in lieu of any part of this application form. A separate application is required for each position for which you wish to apply. Copies
are acceptable. If position qualifications include a postsecondary education requirement, college transcripts are required. Unofficial copies
may be submitted initially, but official copies must be received before an employment recommendation can be made.
1. Are you legally eligible to work in the United States
(Proof of identity and citizenship or immigration status will be required upon employment.)
PERSONAL INFORMATION
YES NO
2. Have you ever been convicted of a felony? If yes, please explain:
(A felony conviction will not necessarily disqualify you for this position.)
YES NO
3. Military service
YES NO
Branch of service
Date
From To
4. Have you ever been involuntarily terminated from any previous position?
If yes, please explain.
YES NO
5. If required by this position, do you have a valid Driver’s License?
YES NO
6. List any applicable certificates or licenses.
IOWA LAKES COMMUNITY COLLEGE, 19 South 7th Street, Estherville, IA 51334
EMPLOYMENT HISTORY
List your work experience below, starting with your most recent, and give a complete accounting of your employment history. You may include
applicable military and volunteer experience. Do not include experience gained as part of an educational program for which you received
credit. If you held more than one job with an employer, list each job separately. Attach a separate sheet if additional space is needed. If
there is any additional information you would like to have considered, or if you need to account for any gaps in your employment history,
please do so in a cover letter and include it with this application.
Employer Address FROM:
Name & Title of Supervisor
Telephone
TO:
Month Day Year
Month Day Year
Your Title
Final Salary
Average number of
hours worked per
week:
Job Duties
Employer Address FROM:
Name & Title of Supervisor
Telephone
TO:
Month Day Year
Month Day Year
Average number of
hours worked per
week:
Job Duties
Employer Address FROM:
Name & Title of Supervisor
Telephone
TO:
Month Day Year
Month Day Year
Average number of
hours worked per
week:
Job Duties
Employer Address FROM:
Name & Title of Supervisor
Telephone
TO:
Month Day Year
Month Day Year
Average number of
hours worked per
week:
Job Duties
Reason for Leaving
Your Title
Final Salary
Reason for Leaving
Your Title
Final Salary
Reason for Leaving
Your Title
Final Salary
Reason for Leaving
Elementary/Secondary (Circle highest grade completed):
High School Graduate or GED?
1 2 3 4 5 6 7 8 9 10 11 12
NOYES
Schools Attended Beyond High School
(Names and Locations)
Dates Attended:
From
Dates Attended:
To
Credits Earned* Field of Study Degree or Certificate
*Enter number of credits and indicate if Semester (S) or Quarter (Q) and Undergraduate (U) or Graduate (G).
EDUCATION
if you are currently working toward a degree, list the degree and the anticipated completion date:
OTHER COURSES TAKEN OR TRAINING/INSTITUTES ATTENDED:
Please list specific computer software experience and/or knowledge.
Month Day Year
TO:
Month Day Year
FROM:Employer Address
Telephone
Name & Title of Supervisor
Average number of
hours worked per
week:
Job Duties
Month Day Year
TO:
Month Day Year
FROM:Employer Address
Telephone
Name & Title of Supervisor
Average number of
hours worked per
week:
Job Duties
Your Title
Final Salary
Reason for Leaving
Your Title
Final Salary
Reason for Leaving
EMPLOYMENT REFERENCES
List three employment references who have knowledge of your qualifications for this position. Do not list relatives.
NAME TELEPHONE TITLE/OCCUPATION/EMPLOYER
The College may contact references other than those listed above. If you do not want your current employer contacted unless
you are one of the final candidates for this position, please check here. If you do not want an employer contacted under any
circumstances, list the employer’s name(s) below. Please understand that this may affect your consideration for the position.
Please Read Carefully and Sign Below…
I certify that the information provided by me in this application is true and complete to the best of my knowledge. I
understand that any misrepresentation or omission may be grounds for rejection of my application for current and
future employment or for termination, if I have been employed.
I acknowledge that it is the responsibility of the College to hire qualified applicants, and that it is the responsibility of
the College to make inquiries as the College, in its discretion, deems relevant to assess work performance. I
authorize the College, or its agents, to contact references, to investigate my background, and to make such other
inquiries as the College deems relevant to assess my qualifications for the position for which I am applying. I release
all parties from any liability for such disclosure and I understand that the information disclosed will not be released to
me.
Finally, I understand that nothing in this application is intended to create an employment contract and that a job offer
is not final until authorized by the President of Iowa Lakes Community College and, if required, by the Board of
Trustees.
Failure to sign and date this form will invalidate your application.
The College is required to maintain a security report in accordance with 34 CFR Part 668 regarding crimes on
campus. This report is available through the address listed for the Human Resources Office.
Iowa Lakes Community College
Human Resources Office
19 South 7th Street
Estherville, IA 51334
(712) 362-0409
Signature of Applicant
Date
RETURN APPLICATION TO:
Iowa Lakes Community College will only accept applications for posted positions
It is the policy of Iowa Lakes Community College not to discriminate on the basis of race, color, national origin, sex,
disability, age (employment), sexual orientation, gender identity, creed, religion and actual or potential parental, family or
marital status in its programs, activities, or employment practices as required by the Iowa Code §§216.6 and 216.9, Titles
VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et
seq.), Title IX (Educational Amendments, 20 U.S.C §§ 1681 – 1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. §
794), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).
If you have questions or complaints related to compliance with this policy, please contact Kathy Muller, Equity & Title IX
Coordinator, 19 South 7th Street, Estherville, IA 51334, 712.362.0433, kmuller@iowalakes.edu, or the Director of the
Office for Civil Rights, U.S. Department of Education, Citigroup Center, 500 W. Madison, Suite 1475, Chicago, IL 60661,
phone number 312-730-1560, fax 312-730-1576.
Iowa Lakes Community College is an Equal Opportunity Employer
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IOWA LAKES COMMUNITY COLLEGE
A P P L I C A N T C O N F I D E N T I A L I N F O R M A T I O N
Not for interview purposes. To be filed separately from application materials.
Applicants are considered for employment and employees are treated without regard to race, color,
religion, sex national origin, age, marital or veteran status, medical condition or disability.
As employers/government contractors, we comply with government regulations and affirmative action
responsibilities.
Solely to help us comply with government record keeping, reporting and other legal requirements,
please fill out the Applicant Confidential Information Form. We appreciate your cooperation. This
data is for periodic government reporting and will be kept in a confidential file separate from the
Employment Application.
DATE:
Position(s) Applied For:
(PLEASE PRINT)
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Walk-in
Iowa Lakes Employee
Friend
Employment
Relative
Other
Agency
Referral Source:
PHONE:
Last
NAME:
First Middle
ADDRESS:
Street City State Zip
AFFIRMATIVE ACTION SURVEY
MaleFemale
Government agencies require periodic reports on the sex, ethnicity, handicapped and veteran status of
applicants. This data is for analysis and affirmative action only. Submission of information about a disability is
voluntary.
Check one:
Check one of the following:
NoYes
Veteran (any era):
NoYes
Disabled:
Asian/Pacific IslanderAmerican Indian/Alaskan Native
Black (not of Hispanic origin)White (not of Hispanic origin)
Other (please specify)Hispanic
IOWA LAKES COMMUNITY COLLEGE, 19 South 7th Street, Estherville, Iowa 51334
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