Fill - Free fillable STAFF APPLICATION FOR EMPLOYMENT PLEASE ANSWER EVERY QUESTION. (Samford University) PDF form

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STAFF APPLICATION FOR EMPLOYMENT

Samford University is an Equal Opportunity Institution that complies with applicable law prohibiting discrimination in its educational and employment

policies and does not unlawfully discriminate on the basis of race, color, sex, age, disability, veteran status, genetic information, or national or ethnic

origin.

PLEASE ANSWER EVERY QUESTION. PRINT CLEARLY IN INK.

Read and complete all requested information on pages 1-4 (Do not refer to resume).

NAME: ________________________________________________________________________________________________

(LAST) (FIRST) (MIDDLE)

LIST ALL PREVIOUS NAMES: _______________________________________________________________________________

ADDRESS: _____________________________________________________________________________________________

(NUMBER) (APT#) (STREET) (CITY) (STATE) (ZIP)

TELEPHONE: (_____) _________________ (____) ___________________ (_____) ______________

(HOME) (BUSINESS) (CELL PHONE)

E-MAIL ADDRESS: ________________________________________

IN CASE OF EMERGENCY CONTACT: __________________________________ TELEPHONE: _______________________

PREVIOUS ADDRESSES IF ADDRESS HAS CHANGED DURING THE LAST SEVEN YEARS: (Add additional sheets if necessary)

______________________________________________________________________________________________________

NUMBER STREET CITY STATE ZIP FROM (DATE) TO

______________________________________________________________________________________________________

NUMBER STREET CITY STATE ZIP FROM (DATE) TO

GENERAL INFORMATION

POSITION PREFERRED: (ONLY ONE ) ___________________________________ SALARY REQUIREMENTS: _________________

ARE YOU ELIGIBLE TO WORK IN THE UNITED STATES OF AMERICA? □ YES □ NO

ARE YOU AT LEAST 18 YEARS OF AGE? □ YES □ NO

WHAT IS YOUR RELIGIOUS AFFILIATION? _____________________________ CHURCH NAME: _________________________

DATE AVAILABLE FOR WORK: _________________________________ REQUIRED DAYS/WEEKS NOTICE: __________

HOURS PREFERRED: □ FULL-TIME □ PART-TIME HOW MANY: _______ HOURS AVAILABLE: □ DAYS ONLY □ ANY SHIFT

HOW WERE YOU REFERRED TO Samford University? ___________________________________________________________________

HAVE YOU PREVIOUSLY COMPLETED AN APPLICATION FOR EMPLOYMENT WITH Samford University? □ YES □ NO

IF YES, WHEN? ______________________________ FOR WHAT POSITION? _________________________________________

HAVE YOU EVER BEEN EMPLOYED BY Samford University? □ YES □ NO

IF YES, IN WHAT DEPARTMENT? _________________________ IN WHAT POSITION? __________________________________

ARE YOU RELATED TO ANY EMPLOYEE OF Samford University? □ YES □ NO

IF YES, WHOM? _____________________________________ IN WHAT DEPARTMENT? ______________________________

(NAME) (RELATIONSHIP)

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EDUCATION

SCHOOL NAME

CITY STATE

MAJOR COURSE

OR SUBJECT

GRADE

AVG

DATES ATTENDED

FROM TO

DEGREE

RECEIVED

HIGH SCHOOL

Did you graduate? ______ Receive a GED? _____

COLLEGE

Did you graduate? __________

COLLEGE

Did you graduate? _________

GRADUATE SCHOOL

Did you graduate? _________

MILITARY TRAINING

BUSINESS/TECHNICAL

LIST SCHOLASTIC HONORS, OFFICES HELD AND ACTIVITIES IN HIGH SCHOOL, COLLEGE AND GRADUATE SCHOOL:

ARE YOU PLANNING TO PURSUE FURTHER STUDIES? □ YES □ NO IF YES, WHEN, WHERE AND WHAT COURSES?

PLEASE LIST ANY CERTIFICATES, LICENSES OR PERMITS YOU HAVE, OR PROFESSIONAL ASSOCIATIONS OF WHICH YOU ARE A

MEMBER OR PROFESSIONAL CERTIFICATIONS OR DESIGNATIONS WHICH YOU HOLD:

COMPUTER SKILLS: ________________________________________________________________________________________

(EXPERIENCE WITH PC HARDWARE, SOFTWARE PACKAGES, ETC.)

OTHER SKILLS: _____________________________________________________________________________________________

(EXAMPLES ARE DICTAPHONE, ACCOUNTING, CRT, OTHER LANGUAGES SPOKEN)

HOW DID YOU OBTAIN THESE SKILLS? □ FORMAL EDUCATION □ WORK EXPERIENCE

□ PROFESSIONAL SEMINAR

PLEASE DISCUSS ANY OTHER SKILLS AND ABILITIES OR EXPERIENCE YOU MAY HAVE WHICH THE OTHER SECTIONS OF THIS

APPLICATION DO NOT GIVE YOU AN OPPORTUNITY TO LIST, THAT YOU FEEL WOULD BE USEFUL IN A POSITION WITH

Samford University:

____________________________________________________________________________________________________________

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EMPLOYMENT RECORD

STARTING WITH PRESENT OR MOST RECENT, LIST PREVIOUS EMPLOYERS. INCLUDE SELF-EMPLOYMENT, SUMMER AND PART-TIME JOBS.

EMPLOYER INFORMATION

POSITION INFORMATION

REFERENCE INFORMATION

EMPLOYER NAME:

TITLE:

SUPERVISOR’S NAME:

FROM:

TO:

NUMBER AND STREET:

DUTIES:

SUPERVISOR’S TELEPHONE:

CITY/STATE /ZIP:

MAY WE CONTACT AT THIS TIME AS A

REFERENCE? □ YES □NO

ARE THEY AWARE THAT YOU

REASON FOR LEAVING:

ARE LOOKING FOR EMPLOYMENT

ELSEWHERE? □ YES □ NO

STARTING SALARY:

ENDING SALARY:

EMPLOYER INFORMATION

POSITION INFORMATION

REFERENCE INFORMATION

EMPLOYER NAME:

TITLE:

SUPERVISOR’S NAME:

FROM: TO:

NUMBER AND STREET:

DUTIES:

SUPERVISOR’S TELEPHONE:

CITY/STATE/ ZIP:

REASON FOR LEAVING:

STARTING SALARY:

ENDING SALARY:

EMPLOYER INFORMATION

POSITION INFORMATION:

REFERENCE INFORMATION

EMPLOYER NAME:

TITLE:

SUPERVISOR’S NAME:

FROM:

To:

NUMBER AND STREET:

DUTIES:

SUPERVISOR’S TELEPHONE:

CITY/STATE /ZIP:

REASON FOR LEAVING:

STARTING SALARY:

ENDING SALARY:

EMPLOYER INFORMATION

POSITION INFORMATION

REFERENCE INFORMATION

EMPLOYER NAME:

TITLE:

SUPERVISOR’S NAME:

FROM: TO:

NUMBER AND STREET:

DUTIES:

SUPERVISOR’S TELEPHONE:

CITY/STATE/ ZIP:

REASON FOR LEAVING:

STARTING SALARY:

ENDING SALARY:

If you need additional space for your Employment Record, please use an additional page as an addendum.

UNEMPLOYMENT RECORD

ACCOUNT FOR ALL PERIODS OF UNEMPLOYMENT OF ANY SIGNIFICANT DURATION OR MORE SINCE YOU LEFT SCHOOL UNTIL THE PRESENT TIME.

(MONTH/YEAR) ___________________________________________________________________________________________________________

FROM TO STATE WHAT YOU WERE DOING

(MONTH/YEAR) _______________________________________________________________________________________________________

FROM TO STATE WHAT YOU WERE DOING

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PLEASE READ BEFORE SIGNING.

IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK BEFORE SIGNING.

I understand that the submission of this Samford University employment application does not mean that I will be offered employment

and in no way obligates Samford University. In the event of my employment, I agree to and will comply with all the rules and policies

of Samford University. I understand that such rules and policies are not contractual and may be amended or modified by Samford

University as it deems necessary. I understand that employment, if offered, is subject to my satisfying employment eligibility

requirements of the federal and state immigration laws.

I understand that either Samford University or I may terminate my employment at any time with or without notice, with or without

cause, and that Samford University does not guarantee that any position will be continued for any length of time or that any job

assignment or shift will be permanent. I also understand that no one other than the President or his designee has the authority to

enter into any agreement for employment for any specified period and such agreement must be in writing and signed by one of these

officers.

I understand Samford University will attempt to verify statements made on my application and made during my employment interview.

When contacted by Samford University, I give my permission for my former employers to answer any and all questions based upon

information available to them in my prior employment records. I understand that it is possible that my prior employment records may

not be accurate. Nonetheless, in consideration of review of this application, I release Samford University and all my former employers

from any liability as a result of the furnishing and receiving of this reference information. I understand that my failure to sign this

reference release so Samford University can contact references and make a full background check of my previous work history may be

deemed a withdrawal of my application.

I understand that I may be required to complete a separate Fair Credit Reporting Act Disclosure and Authorization form in order to

continue with the application process or as a condition of employment. I further understand that in accordance with the Alabama Child

Protection Act of 1999 a criminal records check is mandatory for persons applying for positions that will have unsupervised access to

children under the age of 19.

I certify that all statements that I make on this application and all information submitted in connection with my application for

employment is true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this

application unfavorably. I understand that giving any false, incomplete or misleading statement or misrepresentation on this application

or any information submitted in connection with my application may be considered cause for dismissal whenever discovered.

In connection with Samford University performing an investigation of the above mentioned information, I understand and hereby

authorize Samford University to conduct searches on electronic social networking sites, including but not limited to Twitter.com,

MySpace.com, Facebook.com, LinkedIn.com, Classmates.com, blogs, wikis, user-generated video and audio, and virtual worlds. I also

understand that I am giving Samford University my consent and authorization to conduct searches of the aforementioned media in

spite of any and all privacy protections that may be contained in the terms and conditions of those websites and any efforts I have

made to restrict the information from viewing by the general public or others without specific rights to access the information. I also

hereby release Samford University from any liability in connection with its use of information it finds on electronic social networking

sites and the other related electronic media referenced above. I understand that I do not have any right to privacy or any expectation

of privacy in any information that may be posted on a blog, on the web, on a social networking site or in any place that Samford

University may obtain access as a result of this release.

HAVE YOU EVER PLED GUILTY OR NO CONTEST TO, OR BEEN CONVICTED OF, PAID A FINE FOR, BEEN DIRECTED TO A

PRETRIAL DIVERSION PROGRAM, OR, IN ANY WAY ADMITTED GUILT FOR A CRIMINAL OR DISHONEST ACT, OTHER

THAN A MINOR TRAFFIC VIOLATION? □ YES □ NO IF YES, PLEASE EXPLAIN:

_____________________________________________________________________________________________________________

___________________________________________________________________________________________________________

I hereby acknowledge that I have read and understand these statements and that the information provided on this

application is true and accurate.

SIGNATURE: ________________________________________________ DATE: ________________________________

Rev 03/16

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