Fillable Employment Application PERSONAL INFORMATION Please complete application in (North Central Kansas Technical College)

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Employment Application PERSONAL INFORMATION Please complete application in (North Central Kansas Technical College)

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The Employment Application PERSONAL INFORMATION Please complete application in (North Central Kansas Technical College) form is 4 pages long and contains:

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  • 23 check-boxes
  • 155 other fields

Country of origin: US
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Employment
Application
Please complete application in full and answer all questions completely. Type or print legibly. Indicate N/A if not applicable.
Do not indicate “See Résumé.” A résumé may be attached to provide additional supporting information. Unofficial college
transcripts must be received before being considered for employment. Incomplete applications may not be given
consideration for employment.
PERSONAL INFORMATION
Full Name
Last First Middle
Address
Street/P.O. Box City State Zip
Telephone where you may be contacted:
Home ( ) Work or Alternate ( ) Ext. _ _________
Fax No. ( ) E-Mail Address
Indicate any other names under which your employment or academic records have been filed.
Preferred Name
POSITION INFORMATION
Position applied for
Types of teaching/training qualified to conduct. (Instructional positions only)
EDUCATION
High School Diploma or equivalent: q Yes q No If no, indicate highest grade completed
Names of Colleges or Universities attended (Unofficial College Transcripts Required)
(List most recent education first) Major Minor Degree Earned
EMPLOYMENT
Employment History
Provide complete information for all employment. Begin with present or most recent employment. Attach additional employment
history if necessary. Supplemental sheets are available upon request.
Position:
From To Immediate Supervisor Current/Final Salary
Employer Name:
Address/Phone: ( )
Street City State Zip Phone Ext.
q Full-time q Part-time Duties:
May we contact your current supervisor? q Yes q No
Reason for leaving:
Position:
From To Immediate Supervisor Current/Final Salary
Employer Name:
Address/Phone: ( )
Street City State Zip Phone Ext.
q Full-time q Part-time Duties:
Reason for leaving:
Position:
From To Immediate Supervisor Current/Final Salary
Employer Name:
Address/Phone: ( )
Street City State Zip Phone Ext.
q Full-time q Part-time Duties:
Reason for leaving:
Position:
From To Immediate Supervisor Current/Final Salary
Employer Name:
Address/Phone: ( )
Street City State Zip Phone Ext.
q Full-time q Part-time 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:
From To Reason:
SKILLS AND CERTIFICATIONS
List all valid professional licenses and registrations you hold. Include the certification/registration number and the date of expiration.
Indicate other employment skills, special training, or related courses that you would like considered as part of your application.
Describe significant contributions and achievements, including publications or awards, in professional and/or civic activities that you
would like considered as part of your application.
GENERAL INFORMATION
Are you at least 18 years of age? q Yes q No
Have you been employed by North Central Kansas Technical College?
q Yes q No If so, when?
Are you legally authorized to work in the United States?*
q Yes q No
*As required by federal law, North Central KansasTechnical College will hire only United States citizens and aliens authorized to work in
the United States. All new employees will be required to complete an “Employment Eligibility Verification” (Form I-9) and produce requested
documentation after employment. A list of documents acceptable for proof under the Immigration Reform Control Act of 1986 is available
upon your request.
Have you ever been convicted of, or pleaded “no contest” to, any felony or misdemeanor criminal offense(s), excluding traffic offenses?
q Yes q No If yes, please briefly explain. (A “yes” response will not automatically disqualify you from employment):
Have you ever had your driver’s license suspended or restricted for any reason?
q Yes q No If yes, please briefly explain. (A “yes” response will not automatically disqualify you from employment):
AUTOBIOGRAPHICAL STATEMENT (Faculty Only)
Write a full statement concerning your early environment, travel, military experience, experiences outside of school which may affect
teaching, extra-curricular participation, cultural and vocational interests, and any unique qualifications which may distinguish you from
candidates with otherwise similar qualifications. Please include any evidence that shows you are a people-oriented person. (Limit of
200 words or less)
REFERENCES
(Do not include immediate supervisors listed in EMPLOYMENT section.)
Name Organization Address
( )
Title Phone City State Zip
Name Organization Address
( )
Title Phone City State Zip
Name Organization Address
( )
Title Phone City State Zip
Name Organization Address
( )
Title Phone City State Zip
Information provided on this application will become a part of your permanent personnel record if you are employed by the College. Materials submitted for
consideration as part of an application for employment are not returnable. A résumé or other appropriate materials may be included with the application but
may not be submitted instead of this application. Copies of college transcripts will be required as a part of the application.
NOTICE OF NON-DISCRIMINATION
The NCKTC
Board of Trustees supports and complies with Title VI and Title VII of the Civil Rights Act of 1964 as amended, Section 504 of the Rehabilitation
Ac
t of 1973 and Amendments, The Americans with Disabilities Act, Title IX, and all requirements imposed by or pursuant to the regulations of the
Department of Health and Human Services, and the Department of Education. It is the policy of the Board of Trustees
that no person in the United States
(on
the grounds of race, color, religion, sex, national origin, ancestry or disability) shall be excluded from participation in, denied the benefit of, or otherwise
subjected to discrimination under any program or activity of, or employment with North Central Kansas Technical College.
Specific complaints of alleged discrimination under Title IX (sex) and Section 504/ADA (handicap, disability should be referred to the Title
IX/Section504/ADA Coordinator, 3033 U.S. Highway 24,
Beloit, KS, 67420, 785.738.2276.
APPLICANT CERTIFICATION AND RELEASE AUTHORIZATION (Please read and sign)
I hereby certify that all information provided on or in connection with this application and attachments thereto is true and complete to the best of my
knowledge and I have not knowingly withheld any fact or circumstance. By signature below, I authorize the representatives of North Central Kansas
Technical
College to contact any of my schools, former or current employers or other references needed to provide applicable information to the position
sought. I authorize any and all persons contacted by the College to disclose fully all information available to such persons, whether on record or not,
which may have a bearing on my application or my employment.
I understand that if employed, any misrepresentation of the facts as stated or implied on this application form is sufficient cause for dismissal. This
application does not bind me or the College for any specific period of employment and I understand that nothing in this application creates any
contractual obligation of any kind for either party. If employed, I agree to comply with all policies procedures and regulations of
Technical College and applicable local, state, and federal laws as currently exist or as may exist in the future.
I acknowledge that North Central Kansas Technical College reserves the right to conduct background checks, drug screens and such other testing,
including psychological, on its employees or applicants for employment.
q "Under the Uniform Electronic Transactions Act (K.S.A. 16-1601 et seq.), a document sent electronically may be considered an electronic record. If you
wish to submit your Employment Application Form electronically, check this box and then sign and date below. In so doing, you are hereby certifying
that this electronic submission shall be given the same legal effect as a handwritten signature."
Date /s/
Signature of Applicant
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Employment Application PERSONAL INFORMATION Please complete application in (North Central Kansas Technical College)

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Completed 3 February 2021

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