RELATED EXPERIENCE (YOU MAY ALSO SUBMIT A RESUME
Read experience requirements in job announcement before completing this section. Begin with your most recent job. List all jobs
and any periods of unemployment in last ten years, including any military service. List any jobs held more than ten years ago,
which relate to duties of job for which you are applying. Include number of hours per week that you worked. List any volunteer
experience, which relates to the job for which you are applying.
DATES EMPLOYERS DUTIES
From (Mo. & Yr.) Name of Present or Last Employer Your Title No. Employees
Supervised
To (Mo. & Yr.) Address Duties
Hours Per Week City/State/Zip Code
Highest Monthly Salary
$
Immediate Supervisor’s Name Telephone
May we contact employer? YES NO
Reason for Leaving
From (Mo. & Yr.) Name of Present or Last Employer Your Title No. Employees
Supervised
To (Mo. & Yr.) Address Duties
Hours Per Week City/State/Zip Code
Highest Monthly Salary
$
Immediate Supervisor’s Name Telephone
May we contact employer? YES NO
Reason for Leaving
From (Mo. & Yr.) Name of Present or Last Employer Your Title No. Employees
Supervised
To (Mo. & Yr.) Address Duties
Hours Per Week City/State/Zip Code
Highest Monthly Salary
$
Immediate Supervisor’s Name Telephone
May we contact employer? YES NO
Reason for Leaving
From (Mo. & Yr.) Name of Present or Last Employer Your Title No. Employees
Supervised
To (Mo. & Yr.) Address Duties
Hours Per Week City/State/Zip Code
Highest Monthly Salary
$
Immediate Supervisor’s Name Telephone
May we contact employer? YES NO
Reason for Leaving
ADDITIONAL REMARKS:______________________________________________________________________________________
______________________________________________________________________________________________________________
CERTIFICATION OF APPLICANT: I certify that the statements on this application are true and complete to the best of my knowledge
and belief and that any false statements or incomplete information will subject me to disqualification or dismissal from employment with
the District. I also understand that before my employment becomes effective, verification of minimum qualifications and
documentation verifying my legal right to work in the United States must be filed in the Human Resources Office of the Long Beach
Community College District.
_______________________________________ _____________________________________________
Date Signature of Applicant
EQUAL OPPORTUNITY POLICY
Long Beach Community College District is an Equal Opportunity/Affirmative Action employer and does not discriminate on the basis of race, religious
creed, color, national origin, ancestry, gender, sexual orientation, age (over 40), disability, marital status, medical condition or disability (including
AIDS), other protected classes, or obligations to the National Guard or Reserve forces of the United States.
HR021 10/06
Long Beach City College
Success Center – Tutor/SI Application
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