Fillable ExhibitE-FacultyApplicationFillable WINTHROP UNIVERSITY

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ExhibitE-FacultyApplicationFillable WINTHROP UNIVERSITY

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WINTHROP UNIVERSITY
Rock Hill, South Carolina 29733
Application Form for Faculty and Other Unclassified Positions
Position applied for 'HSDUWPHQW &ROOHJH
Name
(Last) (First) (Middle)
Please indicate any other name(s) under which your educational or employment records may be filed:
Present Address
(Street) (City) (State) (Zip)
Home Phone Other # where you may be reached during the day
Have you ever been convicted of a crime other than a minor traffic violation? (D.U.I./D.W.I must be listed) Yes No
If “yes”, state when, where and the nature of each offense.
Collegiate and Professional Study and Degrees Earned
Institution
Degree
Major Field of Study Date Study Began
Date Degree Awarded
Area of Specialization
Are you legally authorized to work in the United States? Yes No
Are you currently employed with another South Carolina State agency or university? Yes No
If yes, list name of agency or university
Have you been employed by Winthrop in the past? Yes No
If yes, give dates. From
To
Do you have any relatives currently employed at Winthrop University? Yes No If yes, list employee’s
name, department, and relation to you.
South Carolina State Law (59-111-50) prohibits employment with the State to people who have defaulted on certain
student loans, unless they can prove that satisfactory arrangements have been made for repayment. Winthrop University
does verify loan status before an offer of employment is made.
Certification of Applicant
By my signature, I affirm, agree and/or understand that all statements on this form are true and accurate and that any
misrepresentation, falsification or material omission of information or data on this application may result in exclusion from further
consideration or, if hired, termination of employment.
Applicant’s Signature Date
Authority to Release Information
By my signature, I consent to the release of any and all information about me to duly authorized officers, agents and/or employees of
the State of South Carolina which may include but not be limited to information concerning my past and present work (including, without
limitation, discussions with supervisors and others, my official personnel files, attendance records and evaluations), educational records
including transcripts, military service, law enforcement records and/or any personnel or other record or reference deemed necessary,
and to make inquiries of third parties such as credit bureaus. I understand that the release of information may require use of my social
security number. I further release Winthrop University, present and former employers, law enforcement organizations and all third
parties from any and all claims of whatever nature that I may have as a result of any inquiry or response given to such inquiries made in
connection with my application for employment.
Applicant’s Signature Date
Winthrop University is an Equal Opportunity Employer.
Revised 05/13 VPAA
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WINTHROP UNIVERSITY
Applicant Data Record
Applicants are considered for employment without regard to race, color, religion, sex, national origin, age (40+), protected disability,
veteran status or any other characteristic protected under applicable federal, state or local law.
This form will be removed from the application materials prior to being reviewed by the hiring officer or members of the
search committee. Completion of this form is voluntary for applicants and the information provided will not be used in evaluating
qualifications for employment. This form must be completed by final candidates as it contains personal information required to
conduct the employment background check. Additionally, the requested information is used for state and federal reporting and internal
human resources research.
Position applied for Social Security Number
Name (Last) (First) (Middle)
Date of Birth / /
1. Do you consider yourself to be Hispanic or Latino? (Check only one)
Yes, I am Hispanic or Latino
No, I am not Hispanic or Latino
2. Select one or more
of the following racial categories to describe yourself:
American Indian / Alaska Native
Asian
Black / African American
Native Hawaiian / Other Pacific Islander
White
Gender Identity (check one): Male Female
Ö How did you learn about this employment opportunity? (check the one most applicable):
(08) Applied on my own (01) Winthrop JobLine
(09) Encouraged by a current Winthrop employee (02) Job Vacancy Notice
Employee’s name
(03) Newspaper Advertisement
(04) Advertisement in a professional journal (10) Encouraged by another person
or other publication Name
(05) Referred by the South Carolina (11) Website/Internet
Employment Security Commission
Winthrop University (www.winthrop.edu/hr)
(06) Referred by Vocational Rehabilitation
Other (please list)
(07) South Carolina State Career Center (12) Other
EQUAL EMPLOYMENT OPPORTUNITY POLICY
Winthrop University recognizes that employees are the essential resource of the institution. Winthrop is committed to the principles of equal
employment. It is the policy of the University that all personnel related decisions be made without regard to race, color, religion, sex, national origin, age
(40+), protected disability, veteran status or any other characteristic protected under applicable federal, state or local law. This policy applies to all
personnel actions including, but not limited to, recruitment, hiring, classification/compensation, benefits, promotions, transfers, layoffs, recall from layoffs
and educational, social or recreational programs of this institution.
In addition, Title II of the Genetic Information Nondiscrimination Act of 2008 (GINA) protects applicants and employees from discrimination based on
genetic information in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral and other aspects of employment. GINA also
restricts employers’ acquisition of genetic information and strictly limits disclosure of genetic information. Genetic information includes information about
genetic tests of applicants, employees, or their family members; the manifestation of diseases or disorders in family members (family medical history);
and requests for or receipt of genetic services by applicants, employees, or their family members.
The University has developed an Equal Employment Opportunity Plan to assist in achieving the goal of equal employment opportunity for all. The
President of the University is committed to this effort and is ultimately responsible for the development and implementation of equal employment policies.
Specific authority and responsibility for administering the Equal Employment Opportunity Plan has been delegated to the Associate Vice President for
Human Resources, who administers the plan in collaboration with the Vice President for Academic Affairs and their respective staff members. Full
cooperation of all administrators, managers, supervisors and other employees in achieving the goal of equal employment is expected.
No one will be subjected to, and the University prohibits, any form of discipline or retaliation for reporting, pursuing, or cooperating in the investigation of
complaints of employment discrimination that are consistent with this policy.
Equal employment opportunity is an integral part of the mission and purpose of the University. The Winthrop University Equal Employment Opportunity
Plan is available for review in the Office of Human Resources, 303 Tillman Hall, Winthrop University, Rock Hill, SC 29733.
HR – 02/11
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ExhibitE-FacultyApplicationFillable WINTHROP UNIVERSITY

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Completed 3 November 2019

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