Fillable STUDENT EMPLOYMENT APPLICATION (Lehigh Carbon Community College)

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STUDENT EMPLOYMENT APPLICATION (Lehigh Carbon Community College)

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The STUDENT EMPLOYMENT APPLICATION (Lehigh Carbon Community College) form is 2 pages long and contains:

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  • 16 check-boxes
  • 52 other fields

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File type: PDF

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STUDENT EMPLOYMENT APPLICATION
Check one: Spring 2020 Summer 2020 Fall 2020 Date of Application:
**COMPLETE ALL FIELDS**
Incomplete applications will NOT be accepted. Does NOT guarantee employment.
PERSONAL INFORMATION:
Name: L#:
(Last / First / Middle)
Address: ____________________________________________________________________________________
(Street / Apt. / City / State / Zip)
Contact Information: ( ) ( )
Home Telephone Mobile Telephone
College Email Address: @mymail.lccc.edu
Can you provide proof of eligibility to work in the United States? Yes No
If you are under age 18, do you have an employment/age certificate? Yes No
Have you been convicted of or pleaded no contest to a felony within the last five years? Yes No
If yes, please explain:
JOB PREFERENCE:
(Top 3 preferences)
1. 2. 3.
Check here if you are interested in ANY position for which you qualify:
Available Start Date: Are you currently employed? Yes No
Is this your first semester? Yes No
EDUCATION:
(Provide school name, address and graduation date)
High School:
LCCC Major: Anticipated Graduation Date:
Other College or University:
Other Major:
Other Education:
-2-
PERM40-z (AC) 5/1/20
WORK EXPERIENCE:
Please list your work experience for the past five years beginning with your most recent job held. You should account
for time unemployed and include any full-time volunteer work done. If you were self-employed, give firm name.
Attach additional sheets if necessary.
May we contact your current or last employer? Yes No
Current/Last Employer:
Job Title:
From:
To:
Address:
Phone Number:
List your primary responsibilities, skills, and accomplishments with this job:
Reason for leaving (Be specific):
Current/Last Employer:
Job Title:
From:
To:
Address:
Phone Number:
List your primary responsibilities, skills, and accomplishments with this job:
Reason for leaving (Be specific):
Current/Last Employer:
Job Title:
From:
To:
Address:
Phone Number:
List your primary responsibilities, skills, and accomplishments with this job:
Reason for leaving (Be specific):
AVAILABILITY:
List the specific TIMES you are available to work this semester. Example: Mon 9:30am-2:15pm; Tues 1pm-4:30pm
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
How did you hear about this opportunity?
(The Cougar CLAW, Job Board, Facebook, Twitter, Pinterest, Professor, Friend, etc.)
PLEASE READ CAREFULLY
APPLICANT’S CERTIFICATION AND AGREEMENT
I hereby certify that the information set forth in this application is true and correct to the best of my knowledge. I understand that
if employed, falsified statements on this application shall be considered sufficient cause for dismissal. I understand that this
application does NOT guarantee that I will be contacted for an interview or guarantee that I will be hired, due to the high volume
of applications received.
I hereby authorize the college to make an investigation, for employment purposes, of my personal and/or employment history it
deems appropriate, and I further authorize all my previous employers and references to furnish any information concerning my
personal character, habits, or employment records and hereby release all such persons and Lehigh Carbon Community College
from liability or damage incurred as a result of inquiry and furnishing this information.
Type your full name in the Signature box. By typing your name in the Signature box, you certify that you are signing
the completed application.
Signature: Date:
The college is committed to assuring equal opportunity to all persons and does not discriminate based on any protected class under the law. For more
information, go to www.LCCC.edu/nondiscrimination.
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STUDENT EMPLOYMENT APPLICATION (Lehigh Carbon Community College)

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Completed 26 July 2020

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