Fillable MENDOCINO COLLEGE APPLICATION FOR ACADEMIC EMPLOYMENT (Mendocino College)

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MENDOCINO COLLEGE APPLICATION FOR ACADEMIC EMPLOYMENT (Mendocino College)

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The MENDOCINO COLLEGE APPLICATION FOR ACADEMIC EMPLOYMENT (Mendocino College) form is 4 pages long and contains:

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  • 13 check-boxes
  • 190 other fields

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File type: PDF

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MENDOCINO COLLEGE
APPLICATION FOR ACADEMIC EMPLOYMENT
1000 Hensley Creek Road, Ukiah, California 95482
(Telephone) 707-468-3024 (Fax) 707-467-1023
POSITION APPLIED FOR: DATE:
Please complete the entire application. You may attach a cover letter and/or a resume to further demonstrate
your education, skills and abilities qualify you for the position.
CONTACT INFORMATION
Name (Last, First, MI):
Email Address:
Mailing Address (Street or P.O. Box, City, State, Zip)
Contact Telephone (1):
Contact Telephone (2):
EDUCATION (beyond high school)
City, State
Major
Minor
Degree
Date Rec'd
Units
Semester units earned after Bachelor's Degree:
Semester units earned after Master's Degree:
PROFESSIONAL REFERENCES
Title
Organization
Telephone Number (Day)
Mendocino College is an Equal Opportunity Employer.
Unlawful discrimination on the basis of race, color, religion, sex (including sexual harassment), marital status, national
origin, age, physical or mental disability, sexual orientation, or Vietnam Veteran status is
prohibited in all education and employment practices of the college.
NAME:
TEACHING EXPERIENCE (most recent first)
Employment Dates
Employer
City, State
Subjects and Grades Taught
Full-Time or Part-Time %
From
To
N A ME :
Full-Time or
Part-time %
Employment Dates
Employer and Address
Supervisor and Ti tle
Duti es
From
To
Position Title
Telephone Number
Employment Dates
Employer and Address
Supervisor and Ti tle
Full-Time or
Duti es
From
To
Part-time %
Position Title
Telephone Number
Employment Dates
Employer and Address
Supervisor and Ti tle
Full-Time or
Duti es
From
To
Part-time %
Position Title
Telephone Number
Employment Dates
Employer and Address
Supervisor and Ti tle
Full-Time or
Duti es
From
To
Part-time %
Position Title
Telephone Number
Employment Dates
Employer and Address
Supervisor and Ti tle
Full-Time or
Duti es
From
To
Part-time %
Position Title
Telephone Number
I hereby certify that I have provided true, correct and complete answers and statements on this application. I understand
that any omission or misstatement of information made by me on this application, or any supplement to it, shall be
sufficient grounds for failure to employ or for my discharge should I become employed by the Mendocino-Lake Community
College District. My signature below authorizes the District to conduct a background investigation and authorizes release of
information in connection with my application for employment. I waive and release from liability any individual or firm who
may provide information during this investigation, I waive my right of access to any such information, and I hereby release
the District and the reference source from any liability in connection with the release of information or its use by the District.
EXECUTED AT: ON THIS:
City State Day Month Year
SIGNATURE:
Please return the completed forms and send along with any attachments, via e-mail to: HRrecruiting@mendocino.edu or fax to 707-467-1023.
RELEVANT NON TEACHING EXPERIENCE (most recent first)
click to sign
signature
click to edit
APPLICANT SURVEY
MENDOCINO COLLEGE
To assist Mendocino College in complying with Equal Employment Opportunity regulations, please complete the following voluntary
survey and submit it along with your application materials. Once received, the form will be separated from your application
materials and kept confidential. Thank you.
NAME : FEMALE MALE NONBINARY
POSITION APPLIED FOR
Ethnicity (check one):
Disability
The Americans with Disabilities Act states that a
ASIAN (Chinese, East Indian, Japanese, Korean, Laotian, disabled person is anyone who:
Cambodian, Vietnamese, Other Asian)
1.
has a physical or mental impairment
BLACK (African-American)
which substantially limits one or
more major life activities
FILIPINO 2. has a record of such
impairment; or
HISPANIC (Central American, Mexican/Mexican-American,
3. is regarded as having such an impairment
Chicano, South American, Other Hispanic)
AMERICAN INDIAN/ALASKAN NATIVE
Do you have a disability?
Yes No
PACIFIC ISLANDER (Guamanian, Hawaiian)
W HITE (Non-Hispanic)
2+
If you have a disability and require reasonable
accommodation with our selection process,
contact Human Resources at (707) 468-3024,
Room 1160.
How did you hear about this position?
Newspaper - which one
Other
The Mendocino-Lake Community College District is committed to employing qualified administrators, faculty,
and staff members who are dedicated to student success. The Board recognizes that diversity in the academic
environment fosters cultural awareness, promotes mutual understanding and respect, and provides suitable role
models for all students. The Board is committed to hiring and staff development processes that support the goals of
equal opportunity, equity and diversity, and provide equitable consideration for all qualified candidates.
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Completed 4 September 2020

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