Alabama Community College System
Application No.
APPLICATION FOR EMPLOYMENT
Bishop State Community College
Position
Information
Title of position for which you are applying:
Date of Application
Personal
Information
Last Name
First Name
Middle Initial
Address
City
Zip
Contact Information
Phone: Home
Work
Cell
E-mail Address
Secondary and
Postsecondary Education
School/College
Dates Attended
From / To
Major
Minor
Degree(s)
Earned
High
School/
GED
College
College
College
Other
(Specify)
Additional
infromation
Are you currently employed or have been employed within the last twelve months at an Alabama
Community College System college?
Yes No
If yes, list the name of the college(s) and dates: ____________________________________________________
Employment History
Please list most recent employment experience first.
Employer
Telephone Number
Job Duties
Address
Dates of Employment
Title
Full-time
Part-time
Hr. Rate/Salary (optional)
Reason for Leaving
Employment History
(Continued)
Employer
Telephone Number
Job Duties
Address
Dates of Employment
Title
Full-time
Part-time
Hr. Rate/Salary (optional)
Reason for Leaving
Employment History
(Continued)
Employer
Telephone Number
Job Duties
Address
Dates of Employment
Title
Full-time
Part-time
Hr. Rate/Salary (optional)
Reason for Leaving
Employment History
(Continued)
Employer
Telephone Number
Job Duties
Address
Dates of Employment
Title
Full-time
Part-time
Hr. Rate/Salary (optional)
Reason for Leaving
Employment History
(Continued)
Employer
Telephone Number
Job Duties
Address
Dates of Employment
Title
Full-time
Part-time
Hr. Rate/Salary
(optional)
Reason for Leaving
May we contact your current employer? Yes No
Skills, Awards,
Certificates or
Professional
Activities
N
ote: Please provide details of each. May use a separate sheet if necessary.
References
Please list three references, other than relatives, who can provide information verifying qualifications,
character, or work experience.
Name and Title
Address
Phone Number
Family
Relationship
For the purposes of disclosure, relative includes any person related within the fourth degree of affinity or
consanguinity to any job, position, or office of profit with state or with any of its agencies.
Are you a relative of any employee in the Alabama Community College system, including (name of college), or
any member of the Alabama Community College System Board of Trustees? Yes No
If yes, list the name(s), relationship, and employer/position of relative(s):
Felony
Conviction(s)
Have you ever been convicted of or pled no contest or guilty to any felony or any crime involving theft,
dishonesty, violence, or sexual misconduct? Yes No
If yes, explain below:
Consent Agreement
I represent and warrant that the information I have given on this application is full and true to the best of my knowledge and
belief. I further acknowledge that
I understand that I must provide documented verification of education, experience, and
required certifications and/or licensures. And further, I represent and warrant that I have answered fully and truthfully all
questions regarding criminal convictions/records.
I understand that any offer of employment is contingent upon a
satisfactory criminal background investigation and I hereby authorize my employing authority within the Alabama
Community College System and/or its assigns to conduct a criminal background history investigation. I understand
that in the event a conviction for a felony or any crime involving moral turpitude is found that the procedures
established for the Board of Trustees policy concerning criminal background checks will be followed. I further
understand that I will be responsible for the cost of said criminal background check. I hereby expressly request, and
give permission to, former employers and any persons who may have pertinent information concerning this application to
furnish su
ch information to college officials. I agree to hold such persons harmless, and I do hereby release them from any
and all liability for damage of any nature whatsoever for furnishing such information. I understand that failure to provide full
and true information on this application may result in disqualification or dismissal.
Signature of Applicant
Date
Are you a member of the Alabama Community College System Applicant Pool?
Yes
No
B
ishop State Community College
Attention Human Resources
351 N. Broad Street
Mobile, AL 36603
(251)
40
5-7052
It is the policy of the Alabama Community College System, including all postsecondary community and technical colleges under the control
of the Alabama Community College System Board of Trustees, that no employee or applicant for employment or promotion, on the basis of
any impermissible criterion or characteristic including, without limitation, race, color, national origin, religion, marital status, disability, sex,
age, or any other protected class as defined by federal and state law, shall be excluded from participation in, be denied the benefits of, or be
subjected to discrimination under any program, activity, or employment. (Each institution will make reasonable accommodations for
qualified disabled applicants or employees.)
REQUEST, AUTHORIZATION, CONSENT,
AND
RELEASE
FOR BACKGROUND INFORMAT
IO
N
I have been informed and acknowledged that
on
April
13
, 2016
the
Alabama Community College System
Board of Trustees adopted Policy 623.
01
requiring criminal background checks for all new
and
current
employees. ( (
By
signing this authorization, I hereby authorize the Alabama Community
Co
ll
ege System or
its
designee,
to conduct criminal reference searches for felony and misdemeanor convictions at the statewide
and
national levels of every jurisdiction where I currently reside or where I have previously resided during the
past seven years; national sex offender registry searches and a search of my driving record .
I understand that I may voluntarily consent to the use
of
my social security account number for the
purpose of conducting a criminal background check. I further understand that my voluntary consent
to
use my social security account number
is
being requested for purposes of conducting a criminal
background check, pursuant to the authority of the Alabama Community College System Board of
Trustees policy regarding criminal background checks. I understand that neither the Alabama Community
College System nor any employing authority within the Alabama Community College System will deny me
any right, benefit or privilege provided by law because
of
my refusal
to
voluntarily consent
to
the
use
of
my social security account number for the limited purpose of conducting a criminal background check
pursuant to the Alabama Community College System Board of Trustees policy regarding criminal
background checks.
___
I voluntarily consent to the use of my social security account number for the limited
purpose of conducting a criminal background check. Social Security#
______
_
___
I do not consent to the use
of
my social security account number for the limited purpose of
conducting a criminal background check.
___
I consent to the use
of
my driver's license number
to
be
used for the limited purpose of
conducting a review of my driving history.
_ _ I do not consent to the use of my driver's license number for the limited purpose of .
conducting a review
of
my driving history.
1
· (
The information I
ha
ve given
in
my employment application, interviews, and/or relat
ed
resumes
and
documents
is
true, complete, and accurate. ·
I understand
and
agree that if employed, and/or during any period of employment, any false statements,
misrepresentations
of
facts, or omission made by myself become known, my employment sha
ll
be
subject
to immediate termination.
I understand that
in
the event a conviction for a felony or any crime
invo
lving moral turpitu
de
is
found that
the procedures established for the Board
of
Trustees policy concerning criminal background checks will
be fo
ll
owed .
I have read and completely understand this
re
lease.
Applicant's Signature: _ _
_____________
_
Date:
Applicant's Name
(P
lease
print):---------------------
- -
Applicant's
Address:--
-
------------------
- - -
----
Applicant's
Birthday:----------------------
- -
--
-
Applicant's Driver's License Number:
___________________
_ _ _
Applicant's Driver's License State:
-----------------------
Revised March 2019
BISHOP STATE COMMUNITY COLLEGE
EQUAL EMPLOYMENT OPPORTUNITY INFORMATION
(Optional Form)
The following information
is
gathered solely for reporting purposes
and
will not be used to evaluate the applicant's qualifications,
su
itability, or
desirability for employment.
Last Name
Ethnic Background (check one):
( ) Native American
( ) White, not of Hispanic origin
( ) Hispanic
( )
Black, not
of
Hispanic origin
( ) Asian/Pacific Islander
( ) Multi-racial
( ) Other
Have you ever been employed
by
the College?
Position:
First Name
Middle
Gender (check one):
( ) Male
( ) Female
MISCELLANEOUS INFORMATION
( ) Yes ( ) No
From: To:
Name(s}, relationship, and department of relative(s) presently employed by the College:
How did you learn of this job opening?
DOB