Mississippi Delta Community College does not discriminate on the basis of age, race, color, national origin, religion, sex, sexual
orientation, gender identity or expression, physical or mental disability, pregnancy, or veteran status in its educational programs and
activities or in its employment practices. The following person has been designated to handle inquiries regarding the non-
discrimination policies: Steven J. Jones, Vice President of Administrative Services, Tanner Hall, Suite 202, P. O. Box 668, Moorhead,
MS 38761, 662-246-6304; EEOC@msdelta.edu.
REQUEST TO HIRE
Preferred Candidate’s Name: DOB:
Job Title Current Campus/Center Location
Immediate Supervisor’s Name Department/Division
Check One: Part-time Seasonal/Temporary Full-time
Check One: New Position Replacement Position
Reason:
Date of Hire: Pay Rate/Salary: $ Check One: Annually Hourly
Employee Acknowledgement
I certify that I meet all necessary requirements for employment (i.e., minimum qualifications, criminal
background, etc.).
Employee Signature Date
Immediate Supervisor Acknowledgement
We certify that the above-mentioned candidate meets all necessary requirements for employment,
and all necessary documentation has been attached for review (including the employee’s job
application, job description, resume and transcripts (if required), etc.). Thus, we submit this preferred
candidate’s recommendation for full consideration of employment.
Immediate Supervisor’s Signature Date
Division’s Vice President’s Signature Date
Revised 01-27-2021
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signature
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click to sign
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signature
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