Fillable Faculty Application Faculty Employment Application

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Faculty Application Faculty Employment Application

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  • 6 check-boxes
  • 114 other fields

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File type: PDF

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FACULTY EMPLOYMENT
APPLICATION
APPLICANTS ARE CONSIDERED FOR OPEN POSITIONS WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX,
NATIONAL ORIGIN, AGE, MARTIAL STATUS, VETERAN STATUS, OR THE PRESENCE OF A DISABILITY.
PLEASE
PRINT
A
N EQUAL OPPORTUNITY EMPLOYER
Name (Last, First, Middle): Application Date:
Have you ever been employed under a different name? If so, please state name(s): Email Address:
Mailing Address: City: State: Zip:
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:
❏ F
ULL-
TIME
❏ P
ART-
TIME
Are you able to perform the essential functions of the job? ❏ YES ❏ NO If no, explain
Have you ever been convicted of a crime other than a minor traffic violation, served a jail sentence or period of probation subject to a plea
bargain agreement, a plea of nolo contenders, or a court order of adjudication withheld? ❏ YES ❏ NO If yes, explain (This information will
be considered only in relation to specific job requirements.)
Membership in Learned and Professional Societies: ______________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Publications: ______________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Plans for Advanced Study, Research, Consulting, and Publication: __________________________________________________________
________________________________________________________________________________________________________________
E
DUCATION
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: Address: Phone Number:
List people other than relatives or former employers
( )
( )
( )
A
GREEMENT
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 sufficient 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 officer to furnish Jacksonville University with all information at its disposal pertaining to any criminal conviction record on me. I
hereby release Jacksonville University and any law enforcement agency, judicial officer, or other individual from any liability arising from disclosure of
said information.
4. The contents of any faculty handbook or personnel manuals, as well as other University policies and practices, are subject to change or modification by
the University. I also understand that no supervisor or other official of the University (except its Chief Executive Officer) in writing has the authority
to enter into any agreement with me or to make any agreement contrary to the foregoing.
5. This 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.
________________________________________ ____________________
Applicant’s Signature Date
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Faculty Application Faculty Employment Application

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Completed 14 February 2020

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