Fillable Faculty Application for Employment (Eastern New Mexico University)

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Faculty Application for Employment (Eastern New Mexico University)

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Country of origin: US
File type: PDF

U.S.A. forms for Eastern New Mexico University

BROWSE EASTERN NEW MEXICO UNIVERSITY FORMS

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Personal Information
Name: Last First Middle
Address:
Street City State ZIP
Home phone: Contact phone: When can you begin work?
Have you ever worked for ENMU before? q Yes q No
If yes, provide job title, department and dates of employment:
Job title:
Department: From: To:
Are you currently working for ENMU? q Yes q No
If yes, provide job title, department and date hired:
Job title:
Department: From: To:
Are you a citizen of the United States? q Yes q No
If you are not a citizen of the United States, do you have the legal right to work in the United States? q Yes q No
If you are not a citizen, but have answered
yes above, please provide your visa or work number:
Have you ever been convicted, after age 18, of a felony? q Yes q No
If yes, please explain, on the Pre-Employment Conviction Information Form (obtain from Personnel).
Do you have any relatives who presently work at ENMU? q Yes q No
If yes, provide name(s) and relationship(s):
Name:
Relationship:
Name: Relationship:
Attach a current, complete curriculum vitae indicating educational history,
record of employment and any other important information.
Applicant Certification
I certify that the information submitted in this application process is correct and complete to the best of my knowledge and belief.
I understand that knowingly making a false statement or omission in this application may be sufcient cause for rejection of this
application or dismissal after employment. I hereby authorize Eastern New Mexico University to inquire as to my record with any of
my former employers or my present employer with no liability arising there from.
Applicant signature: Date:
Eastern New Mexico University is an Afrmative Action and Equal Opportunity Employer. The University does not discriminate on the basis
of race, color, religion, national origin, sex, age, disability or veteran status in its programs, activities or employment. Persons seeking additional
information about the University’s nondiscrimination policy should contact the Afrmative Action Ofcer, ENMU Station 21, 1500 S. Ave. K,
Portales, NM 88130. The University will endeavor to maintain the condentiality of the information contained in this application.
(Type or print all information in ink)
Faculty Application for Employment
Position Applying For: Department:
www.enmu.edu
OCS • S0290 • 3/10
Pre-Employment Background Investigation
Disclosure and Authorization Form
Human Resources
www.enmu.edu
Disclosure
Eastern New Mexico University (the “University”) may request background information about you from a consumer
reporting agency in connection with your employment application and for employment purposes. This information may
be obtained in the form of consumer reports and/or investigative consumer reports. These reports may be obtained at
any time after receipt of your authorization and, if you are hired by the University, throughout your employment.
HireRight, Inc., or another consumer reporting agency, will obtain the reports for the University. HireRight, Inc.
is located at 5151 California, Irvine, CA 92617, and can be contacted at 800-400-2761. The reports may contain
information bearing on your character, general reputation, personal characteristics, mode of living and credit standing.
The types of information that may be obtained include, but are not limited to: social security number verications;
credit reports; criminal records checks; public court records checks; driving records checks; educational records
checks; employment verications; personal and professional references checks; licensing and certication records
checks; drug testing results; etc. The information contained in the reports will be obtained from private and public
record sources, including, as appropriate, personal interviews with sources, such as neighbors, friends and associates.
You may request more information about the nature and scope of any investigative consumer reports by contacting the
University. A summary of your rights under the Fair Credit Reporting Act is also being provided to you.
Additional State Law Notices
If you are a California, Maine, New York or Washington applicant, please also note:
California: Under section 1786.22 of the California Civil Code, you may view the le maintained on you by
HireRight during normal business hours. You may also obtain a copy of this le, upon submitting proper identication
and paying the costs of duplication services, by appearing at HireRight’s ofces in person, during normal business
hours and on reasonable notice, or by mail. You may also receive a summary of the le by telephone, upon submitting
proper identication. HireRight has trained personnel available to explain your le to you, including any coded
information. If you appear in person, you may be accompanied by one other person, provided that person furnishes
proper identication.
New York: You have the right, upon request, to be informed of whether or not a consumer report was requested. If
a consumer report is requested, you will be provided with the name and address of the consumer reporting agency
furnishing the report. You may inspect and receive a copy of the report by contacting that agency.
Maine: You have the right, upon request, to be informed of whether an investigative consumer report was requested,
and if one was requested, the name and address of the consumer reporting agency furnishing the report. You may
request and receive from the University, within ve business days of our receipt of your request, the name, address
and telephone number of the nearest unit designated to handle inquiries for the consumer reporting agency issuing
an investigative consumer report concerning you. You also have the right, under Maine law, to request and promptly
receive from all such agencies copies of any such reports.
Washington State: If we request an investigative consumer report, you have the right, upon written request
made within a reasonable period of time after your receipt of this disclosure, to receive from us a complete and
accurate disclosure of the nature and scope of the investigation we requested. You also have the right to request from
the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit
Reporting Act.
OCS · T1057 · 6/10
Authorization
I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under
the Fair Credit Reporting Act. By my signature below, I consent to the release of consumer reports and investigative
consumer reports prepared by a consumer reporting agency, such as HireRight, Inc., to the University and its
designated representatives and agents. I understand that if the University hires me, my consent will apply, and the
University may obtain reports, throughout my employment.
I also understand that information contained in my job application or otherwise disclosed by me before or during my
employment, if any, may be used for the purpose of obtaining consumer reports and/or investigative consumer reports.
By my signature below, I authorize law enforcement agencies, learning institutions (including public and private
schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state
and local), motor vehicle records agencies, my past or present employers, the military, and other individuals and
sources to furnish any and all information on me that is requested by the consumer reporting agency.
By my signature below, I certify the information I provided on this form is true and correct. I agree that this
Disclosure and Authorization form in original, faxed, photocopied or electronic (including electronically signed) form
will be valid for any reports that may be requested by or on behalf of the University.
Applicant Information
Applicant name:
Last First Middle intial
Social Security number: Date of birth (for ID purposes only):
Present address:
Street City State ZIP
Driver’s license number:
Applicant signature: Date:
California, Minnesota or Oklahoma applicants only
You will be provided with a free copy of any consumer reports or investigative consumer reports obtained on you if
you check the box below.
q I wish to receive a free copy of the report.
OCS · T1057 · 6/10
Dear Applicant:
Thank you for your application for employment at Eastern New Mexico University. State and federal regulations
require this institution to compile information concerning race and gender.
To assist us in complying with these requirements and our advertising efforts, we ask that you complete and return
this Condential Data Survey. Submission of the requested information is voluntary and anonymous and will have no
bearing on your employment opportunity.
Thank you for your cooperation.
Position applied for:
Department:
Sex: q Male q Female
Ethnicity:
Please indicate whether you consider yourself to be Hispanic/Latino: q Yes q No
In addition, select one or more of the following racial categories to describe yourself:
q American Indian or Alaskan Native q Asian q Black or African-American
q Native Hawaiian or other Pacific Islander q White or Non-Hispanic
How did you discover this employment opportunity? Check one:
q Professional journal, please specify:
q Chronicle of Higher Education
q Employment agency
q Newspaper (or newspaper-related Website)
q Clovis News Journal q Portales News–Tribune
q Albuquerque Journal q Amarillo Globe News
q Lubbock Avalanche
q Other newspaper, please specify:
q Internet
q ENMU Website
q www.monster.com
q www.enmjobfinder.com
q www.higheredjobs.com
q Other Website, please specify:
q Other source, please specify:
Eastern New Mexico University is an afrmative action and equal opportunity employer. The University does not discriminate on the basis
of race, color, national origin, ancestry, religion, sex, age, disability, or veteran status in programs, activities or employment. Persons seeking
additional information about the University’s nondiscrimination policy should contact the Afrmative Action Ofcer, ENMU Station 21, 1500 S.
Ave K., Portales, NM 88130.
Confidential Data Survey
www.enmu.edu
Employee Information
OCS • S0290 • 3/10
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Faculty Application for Employment (Eastern New Mexico University)

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Completed 22 July 2020

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