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
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
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
Signature of Applicant
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, email@example.com, 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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