Employment History
Employed - (State month and year)
From To
Brief description of job duties:
May we contact this employer?
Employed - (State month and year)
From To
Brief description of job duties:
May we contact this employer?
Employed - (State month and year)
From To
Brief description of job duties:
May we contact this employer?
Employed - (State month and year)
From To
Brief description of job duties:
May we contact this employer?
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, martial status, ancestry, gender identity or expression, or sexual orientation in its educational programs, activities,
admissions, services, 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. Lenny Klaver, Frey Administrative Center, 1301 Main Street, phone extension 1200, or lklaver@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 the 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:
NCMC publishes the Annual Public Safety Report, in compliance with the Jeanne Cleary Disclosure of Campus Security Policy and Campus Crime Statistics Act.
This report includes statistics for the previous three years concerning reported crimes that occurred on-campus; in certain off-campus buildings or property
owned or controlled by NCMC; and on public property within, or immediately adjacent to and accessible from the campus. The report also includes institutional
policies concerning campus security, such as policies concerning sexual assault and other matters. The Annual Public Safety Report can be accessed via the
following link: www.ncmissouri.edu/about/Pages/safety-report.aspx.
The Fire Safety Report, in compliance with the Higher Education Act, provides fire statistics, information about fire safety, and other pertinent information. The
report can be accessed via the following link:
www.ncmissouri.edu/about/Pages/fire_ safety _
report.aspx.
In accordance with federal regulations set forth by The Higher Education Act of 1965, as amended, NCMC’s Student Consumer Information is available at the
following site: www.ncmissouri.edu/hea.
Paper copies of these documents can also be obtained by contacting the Dean of Student Services (660) 359-3948 x1400.
Revised September, 2019
click to sign
signature
click to edit
![]()
