NCMC Student Employment Application
North Central Missouri College (NCMC) | 1301 Main Street | Trenton, MO 64683 1-660-359-3948 1-660-359-5113
PLEASE READ BEFORE COMPLETING: Read the form carefully and follow directions. Return the
completed application along with a copy of your resume to Kristi Harris kharris@mail.ncmissouri.edu or Frey
Administration Building. Federal work study and Non-Work Study student employment monies are limited
and neither qualification nor submission of an application guarantees employment.
PERSONAL
Last Name First Name Middle Initial
Todays Date
Street Address
Student ID #
City, State, Zip
Telephone #
Position(s) Applied For:
Where did you learn of this opening?
Can you provide legal proof of eligibility to work in the United States?
List any other experience, skills or qualifications that should be considered in evaluating you for employment
opportunities.
EDUCATION
Type of School
Name and Location of School
Course of
Study
Did you
Graduate?
Degree or
Diploma
Graduate
Yes
No
College
Yes
No
Business/Trade
Technical
Yes
No
High School/
G.E.D.
Yes
No
Have you ever been convicted of a crime? No Yes
State names of relatives working for NCMC and their relationship to you:
Employee: Relationship:
Do you require reasonable accommodation to perform the essential functions of the job for which you are
applying?
No Yes
Are you able to work a night/weekend schedule? No Yes
REFERENCES: Give the names of three persons not related to you, whom you have known at least three years.
Name Address, phone, e-mail Company Years Known
Revised January 14, 2016
Employment History
1
Company Name
Telephone
Address
Employed (State month and Year)
From To
Name of Supervisor
Reason for Leaving
State Job Title and Describe Your Work:
Ending Salary $
2
Company Name
Telephone
Address
Employed (State month and Year)
From To
Name of Supervisor
Reason for Leaving
State Job Title and Describe Your Work:
Ending Salary $
3
Company Name
Telephone
Address
Employed (State month and Year)
From To
Name of Supervisor
Reason for Leaving
State Job Title and Describe Your Work:
Ending Salary $
4
Company Name
Telephone
Address
Employed (State month and Year)
From To
Name of Supervisor
Reason for Leaving
State Job Title and Describe Your Work:
Ending Salary $
NCMC is committed to assuring equal opportunity to all persons and does not discriminate on the basis of race, color, national origin, sex,
disability, religion, age, genetic information, veteran status, ancestry, gender identity or expression, or sexual orientation in its educational
programs, activities, admissions, or employment practices as required by Title IX of the Education Amendments of 1972, Title VI of the
Civil Rights Act of 1964, the Rehabilitation Act of 1973, the Americans with Disabilities Act, other applicable statutes and college policy.
Sexual harassment, to include sexual violence, is a form of sex discrimination and is prohibited. Inquiries concerning these statutes and
nondiscrimination policies should be referred to the College President, Dr. Neil Nuttall, Frey Administrative Center, 1301 Main Street, (660)
359-3948 x1200, or nnuttall@mail.ncmissouri.edu.
I authorize NCMC to verify any information contained within this application and contact references I have provided. I release NCMC
from all liability that might result from making an investigation. I understand that neither completion of this application nor any other part
of the consideration for employment process, establishes any obligation for NCMC to hire me. I understand that no representative of
NCMC has that authority to make any assurance to the contrary.
I attest with my signature below I have given true and complete information on this application and no
requested information
has been
concealed. If any information I have provided is untrue or concealed, I understand this will constitute cause for the denial of employment
or immediate dismissal.
Date:
Signature:
click to sign
signature
click to edit
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