INSTRUCTOR APPLICATION
Three Rivers Community College does not discriminate on the basis of race, color, religious creed, age, gender, gender identity or
expression, national origin, marital status, ancestry, present or past history of mental disorder, learning disability or physical
disability, veteran status, sexual orientation, genetic information or criminal record.
PERSONAL INFORMATION
NAME
Last First MI
ADDRESS
Street
TELEPHONE ( ) ( )
City State Zip Code
EMAIL ADDRESS_______________________________
Home Cell
TRCC COURSE(s) YOU ARE APPLYING TO TEACH:
(The TRCC course name and number must be included in order to direct your application to the appropriate department. Please visit
www.trcc.commnet.edu for complete course listing)
SCHOOL INFORMATION
HIGH SCHOOL NAME:
ADDRESS
Street City State Zip Code
TELEPHONE ( ) EMAIL ADDRESS______________________________________________
PRINCIPAL NAME: _________________________________________
TELEPHONE ( ) EMAIL ADDRESS______________________________________________
I understand that I am required to adhere to all standards set by Three Rivers Community College. I also understand that professional
development and workshop attendance are necessary to teach 3RCC courses. My principal has allowed release time to attend workshops on
campus.
Instructor Signature: _______________________________________
Date: _____________________
This application must be submitted with a resume and transcripts (unofficial) from undergraduate and graduate studies.
SOCIAL SECURITY # ___________________________ DATE OF BIRTH ________________________
Social Security Number and Date of Birth are requested for the accuracy of records and other business purposes.
EDUCATIONAL BACKGROUND
It is the policy of the Board to recognize only those degrees granted by regionally accredited institutions of learning. If the institution of higher learning is
located outside the United States, you are responsible for providing documentation from a recognized USA accrediting service which specializes in
determining foreign education equivalencies. The responsibility for and costs associated with obtaining equivalency information rests with the applicant.
Dates
(From-To)
Institution
Location
(City, State)
Degree
Awarded
(e.g. BA,, MBA)
Major/Area of
Concentration
Please list any license or professional designation (e.g. P.E., C.P.A.)
INSTRUCTIONAL EXPERIENCE
(List in reverse chronological order beginning with your current/last position)
Dates
Institution & Location
Course(s) Taught
(From To)
OTHER RELEVANT EMPLOYMENT EXPERIENCE
(List in reverse chronological order beginning with your current/last position)
Dates
Organization & Location
Position
(From To)
OTHER PROFESSIONAL DEVELOPMENT, CONTINUING EDUCATION, OR INFORMATION THAT YOU WOULD
LIKE US TO CONSIDER IN YOUR APPLICATION TO TEACH THREE RIVERS COMMUNITY COLLEGE COURSES:
Send completed application and materials to:
Erin Sullivan, Coordinator
College Career Pathways
Three Rivers Community College
574 New London Turnpike
Norwich, CT 06360
ESullivan@trcc.commnet.edu
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