Fillable MENDOCINO COLLEGE APPLICATION FOR CLASSIFIED EMPLOYMENT 1000 Hensley (Mendocino College)

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MENDOCINO COLLEGE APPLICATION FOR CLASSIFIED EMPLOYMENT 1000 Hensley (Mendocino College)

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The MENDOCINO COLLEGE APPLICATION FOR CLASSIFIED EMPLOYMENT 1000 Hensley (Mendocino College) form is 3 pages long and contains:

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  • 2 check-boxes
  • 79 other fields

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MENDOCINO COLLEGE
APPLICATION FOR CLASSIFIED EMPLOYMENT
1000 Hensley Creek Road, Ukiah, California, 95482
(Telephone) 707-468-3062 (Fax) 707-467-1023
POSITION APPLIED FOR:
Complete the entire application which is used for preliminary screening purposes.
If needed, you may attach a letter and/or resume to further demonstrate your ability to meet the qualifications
for the position.
PERSONAL INFORMATION
Name (Last, First, MI):
Email Address:
Mailing Address (Street or P.O. Box, City, State, Zip)
Contact Telephone (1):
Contact Telephone (2):
EDUCATION
Institution
City, State
Major
Degree
High School:
College:
If applicable to position, list office machines you can operate
including computers and software:
If applicable to position, languages other than English that you
can speak, read, or write:
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.
RELEVANT EXPERIENCE (most recent first) Attach an additional page if needed.
Employment Dates Employer and Address Supervisor and Title Full-Time or Duties
From To Part-time %
Position Title Telephone Number
Employment Dates Employer and Address Supervisor and Title Full-Time or Duties
From To Part-time %
Position Title Telephone Number
Employment Dates Employer and Address Supervisor and Title Full-Time or Duties
From To Part-time %
Position Title Telephone Number
Employment Dates Employer and Address Supervisor and Title Full-Time or Duties
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.
click to sign
signature
click to edit
APPLICANT SURVEY
MENDOCINO COLLEGE
To assist Mendocino College in complying with Equal Opportunity regulations, please complete the following voluntary survey and submit along with your
application materials. Once received, the form will be separated from your application materials and kept confidential.
Thank you.
NAME FEMALE MALE
POSITION APPLIED FOR
Ethnicity (check one): Disability
NONBINARY
ASIAN (Chinese, East Indian, Japanese, Korean, Laotian, The Americans with Disabilities Act states that a disabled
Cambodian, Vietnamese, Other Asian) person is anyone who:
1 has a physical or mental impairment
BLACK (African-American) which substantially limits one or more
major life activities
FILIPINO
HISPANIC (Central American, Mexican/Mexican-American,
2 has a record of such impairment; or
Chicano, South American, Other Hispanic) 3 is regarded as having such an impairment
AMERICAN INDIAN/ALASKAN NATIVE Do you have a disability? Yes No
PACIFIC ISLANDER (Guamanian, Hawaiian) If you have a disability and require reasonable
accommodation with out selection process, contact
WHITE (Non-Hispanic) Human Resources at 468-3062, Room 1160.
_______________ 2+
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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MENDOCINO COLLEGE APPLICATION FOR CLASSIFIED EMPLOYMENT 1000 Hensley (Mendocino College)

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Completed 4 September 2020

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