Please list three references, other than relatives, who can provide information verifying qualifications,
character, or work experience.
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):
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
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 fur
ther, 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
ion to, former employers and any persons who may have pertinent information concerning this application to
furnish such information to college officials. I agree to hold such persons harmless, and I do hereby release them from any
and all liability for da
mage 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.
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Division of Human Resources
Alabama Community College System
Delivery Address: 135 South Union Street Mailing Address: Post Office Box 302130
Montgomery, AL 36104 Montgomery, AL 36130-2130
Telephone (334) 293-4603 or (334) 293-4628
ACCS is an equal opportunity employer. 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, shall be discriminated against on the basis of any impermissible criterion or characteristics including, without
limitation, race, color, national origin, religion, martial status, disability, sex, age or any other protected class as defined by federal and state
law. ACCS will make reasonable accommodations for qualified disabled applicants or employees.