STUDENT WORKER
APPLICATION FOR EMPLOYMENT
I. PERSONAL DATA:
Date of Application
Are you at least 18 years of age?
Yes No
Other last name(s) you have used
Name: Last, First, Middle
Home Phone
Street or Rural Route Address
Alternate Phone
City/State
Zip
Email Address
Have you ever been convicted of a felony? Yes No
If yes, please describe circumstances on a separate sheet and
attach.
Are you authorized to work in the United States? Yes No
(Proof of citizenship or eligibility for immigration work authorization is
required upon employment.)
II. POSITION APPLYING FOR:
Level: Student Worker Do you have a specific position for which you would like to apply? Yes No
List position(s) title: ________________________________________________________________
Have you ever been employed at ECC before? Yes No If yes, when: (Mo./Yr.) ______to (Mo./Yr.) ______
Position Held: ____________________________________ Former Supervisor: ______________________________
Are you currently enrolled at ECC? Yes No If yes, please list the terms: Spring Summer Fall
Have you completed your FAFSA? Yes No
What semesters are you available for student work-study? Spring ______ Summer______ Fall______
Days Available: ____________________________________ Hours Available: ______________________________
III. EDUCATION: Official transcript(s) will be required for all college work indicated.
Name of Institution
Graduated?
Degree
Obtained
Major
High School or GED
Yes No
N/A
N/A
College or Other Training
Yes No
College or Other Training
Yes No
HR Use Only:
F.A. Approved Yes No
Office of Human Resources
1964 Prairie Dell Road
Union, MO 63084
636-584-6710
www.eastcentral.edu
Revised: 03/19/2014
2
In compliance with the federal Student Right-to-Know Act and the Campus Security Act, information regarding campus (and off-campus) crimes, safety
and security policies and procedures, and student graduation rates are available at www.eastcentral.edu/business/leadership/institutionalresearch. Copies
may also be obtained by contacting the Office of Institutional Research, Assessment and Planning.
IV. EMPLOYMENT HISTORY: (Please list present and previous work experience/periods of employment or
provide a current resume.) Check if resume is attached.
Company
Current Position
From (Mo./Yr.)
To (Mo./Yr.)
Street Address
Full-time Part-time Temporary # Hours per week: _____
City
Zip
Summarize Main Duties
Phone
Summarize Reason for Leaving
Company
Former Position
From (Mo./Yr.)
To (Mo./Yr.)
Street Address
Full-time Part-time Temporary # Hours per week: _____
City
Zip
Summarize Main Duties
Phone #
Summarize Reason for Leaving
V. AUTHORIZATION FOR RELEASE OF INFORMATION: READ CAREFULLY BEFORE SIGNING
Unsigned applications will not be considered for employment..
I hereby authorize my current and former employers and references to furnish any information about me and about my work experience. I
release my current and former employers and references from any and all liabilities or damages of any nature as a result of providing such
information. My current and former employers and references may rely on a signed copy of this release. I certify that the answers given in this
application are true and complete to the very best of my knowledge. In the event I am employed by East Central College and in the further event
that I have provided false or misleading information or made an omission of material fact in this application or in subsequent employment
interviews, I understand that my employment may be terminated at any time after discovery of the false or misleading information. I understand
that this application will be considered active for twelve months. I understand that if I wish my candidacy to remain open after that date I must
submit another application. I understand that East Central College is required to participate in E-verify.
Signature of Applicant: Date:
NOTICE OF NON-DISCRIMINATION Applicants for admission and employment, students, employees, and sources of referral of applicants
for admission and employment and individuals with whom the Board of Trustees and college officials do business are hereby notified that East
Central College does not discriminate on the basis of race, color, religion, national origin, ancestry, gender, sexual orientation age, disability,
genetic information or veteran status. Inquiries related to employment practices may be directed to Human Resources Director, 005-D
Multipurpose Building, telephone number 636-584-6710 or hrnotice@eastcentral.edu.
12/19/16
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