FACULTY EMPLOYMENT
APPLICATION
A
PPLICANTS ARE CONSIDERED FOR OPEN POSITIONS WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL
ORIGIN, AGE, MARTIAL STATUS, VETERAN STATUS, SEXUAL ORIENTATION, GENDER IDENTITY, OR THE PRESENCE OF ADISABILITY.
PLEASE PRINT
AN EQUAL OPPORTUNITY EMPLOYER
N :etaD noitacilppA:)elddiM,tsriF,tsaL( ema
Have you ever been employed under a dierent name? If so, please state name(s): Email Address:
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Home Phone: Social Security Number: Are you legally eligible for employment in the U.S.?
Y
ES
N
O
Work Phone: Proof of employment eligibility will be required upon employment.
Position Applied For:
Status Desired: Preferred Course Assignments:
FULL-TIME PART-TIME
Are you able to perform the essential functions of the job? YES NO If no, explain
Membership in Learned and Professional Societies: ______________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Publications: ______________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Plans for Advanced Study, Research, Consulting, and Publication: __________________________________________________________
________________________________________________________________________________________________________________
EDUCATION
Doctoral Dissertation Title:
Honors and Distinctions, including Honorary Societies:
Institutions Attended: Dates of Attendance Major Minor Degrees Received/Date
________________________________________________________________________________________________________________
EMPLOYMENT EXPERIENCE
Employer:
Address:
Supervisor, Title & Phone Number:
May we contact this employer? YES NO
Reason for Leaving:
Date Employed:
From To
Salary:
Starting Final
Responsibilities:
Employer:
Address:
Supervisor, Title & Phone Number:
May we contact this employer? YES NO
Reason for Leaving:
Date Employed:
From To
Salary:
Starting Final
Responsibilities:
Employer:
Address:
Supervisor, Title & Phone Number:
May we contact this employer? Y
ES
N
O
Reason for Leaving:
Date Employed:
From To
Salary:
Starting Final
Responsibilities:
Employer:
Address:
Supervisor, Title & Phone Number:
May we contact this employer? YES NO
Reason for Leaving:
Date Employed:
From To
Salary:
Starting Final
Responsibilities:
Start with your present or most recent job
SPECIAL SKILLS AND EXPERIENCE
Administrative Experience __________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
PROFESSIONAL/PERSONAL REFERENCES
Name & Occupation: A :rebmuN enohP:sserdd
List people other than relatives or former employers
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1. I certify that all information provided herein is true and complete to the best of my knowledge.
2. I understand that any false statements or omission of information in this application may be sucient cause for disqualifying my application from
consideration or, if hired, for discharge.
3. I hereby authorize Jacksonville University to verify all statements contained in this application, and to contact all references, employers (except as
limited by me herein), or any other persons or agencies having information relative to such statements. I request any duly constituted law enforcement
agency or judicial ocer to furnish Jacksonville University with all information at its disposal pertaining to any criminal conviction record on me. I
hereby release Jacksonville University or other individual from any liability arising from disclosure of said information.
5. e contents of any faculty handbook or personnel manuals
, as well as other University policies and practices, are subject to c hange or modication by
the Universit
y. I also understand that no supervisor or other ocial of the University (except its Chief Executive Ocer) in writing has the authority
to enter into any agreement with me or to make any agreement contrary to the foregoing.
6. is application will remain active for ninety (90) days. Any applicant wishing to be considered for employment beyond ninety (90) days should
reapply. Applicants needing accommodations due to disability in connection with applying for a position should contact the Human Resources
Department at (904) 256-7025.
I certify that I have read, understand, and agree with all items listed above.
________________________________________ ____________________
4. I understand that Jacksonville University has not requested information regarding the existence of a criminal background at this time. However, I
understand that Jacksonville University conducts background checks on all individuals oered employment with the University and that any oer of
employment will be conditioned on the result of a background investigation. I further understand that certain information in the background check may
disqualify me from employment even if I am otherwise the most qualied applicant for employment.
Applicant’s Signature Date
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