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.
