Fillable Prior Work Experience Collection Form for MSUAASF Note: (Saint Cloud State University)

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Prior Work Experience Collection Form for MSUAASF Note: (Saint Cloud State University)

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Prior Work Experience Collection Form for MSUAASF
Name: ____________________________________________ Position: _______________________________________
Note: The information on this form is used to calculate your potential base salary. All information must be included, and all
information must be true and accurate. The University cannot adjust your base salary in the future based on incomplete or inaccurate
information.
Professional-level teaching, administrative experience, or student service within all MinnState or outside Colleges/Universities:
(credit is given at 100%)
Hours Begin End Actual Yrs of
Job Title/Position Institution Per Week Mo/Yr Mo/Yr Experience
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
Professional-level teaching & administrative experience in K-12 (e.g., teacher, librarian, principal, superintendent, etc):
(credit given at 50%)
Hours Begin End Actual Yrs of
Job Title/Position Institution Per Week Mo/Yr Mo/Yr Experience
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
Professional level experience outside of education ONLY if the work experience is directly related to the MSUAASF position upon
hire: (credit is given at 100%)
Hours Begin End Actual Yrs of
Job Title/Position Institution Per Week Mo/Yr Mo/Yr Experience
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
Clerical/Technical/Paraprofessional Experience within/or outside MinnState institutions ONLY if the work experience is directly
related to the MSUAASF position upon hire: (credit is given at 50%)
Hours Begin End Actual Yrs of
Job Title/Position Institution Per Week Mo/Yr Mo/Yr Experience
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
Graduate/teaching assistantships Experience within/or outside MinnState institutions ONLY if the work experience is directly related
to the MSUAASF position upon hire: (credit is given at 50%)
Hours Begin End Actual Yrs of
Job Title/Position Institution Per Week Mo/Yr Mo/Yr Experience
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
Volunteer Experience Professional-level experience ONLY if a) the work experience is directly related to the MSUAASF position
upon hire and b) if percent time is listed and c) volunteer work does not overlap with other experience credited: (credit is given at
100%)
Hours Begin End Actual Yrs of
Job Title/Position Institution Per Week Mo/Yr Mo/Yr Experience
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
Minnesota Statute 192.261 required recognition of years of military service which resulted from conscription (drafted) and which
interrupted service in the Minnesota State Colleges and University system: (credit is given at 100%)
Hours Begin End Actual Yrs of
Job Title/Position Institution Per Week Mo/Yr Mo/Yr Experience
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
___________________________ _________________________ ________ _______ _______ _______
I attest that all statements and representations set forth above are true and accurate. Inaccurate statements or misrepresentations
concerning my work experience may lead the University to take one or more of the following actions: withdrawal of an offer of
employment; modification of starting salary; and, in the event that I become an employee, disciplinary action up to and including
discharge.
_________________________________________ ___________________________________________ ___________
Candidate’s Name Candidate’s Signature Date
_________________________________________ ___________________________________________ ____________
Supervisor’s Name Supervisor’s Signature Date
updated 7/23/19
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Prior Work Experience Collection Form for MSUAASF Note: (Saint Cloud State University)

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Completed 25 August 2020

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