Employment History (continued):
2. Employer: Phone Number:
Type of Business: Supervisor:
Employed from to May we contact? Yes No
Duties:
Reason for leaving?
3. Employer: Phone Number:
Type of Business: Supervisor:
Employed from to May we contact? Yes No
Duties:
Reason for leaving?
4. Employer: Phone Number:
Type of Business: Supervisor:
Employed from to May we contact? Yes No
Duties:
Reason for leaving?
References (name, business, relationship, telephone):
1.
2.
3.
To the best of my knowledge, all information on this application is true and correct. I authorize Wichita State University to
use the information given in determining my eligibility for employment, including contacting each of my former employers
listed concerning my qualifications for employment. Permission is also granted to each of my former employers to give
Wichita State University information they may have with respect to my work experience with them. I understand that
fraudulent statements made in this application may be cause for disqualification for employment at or dismissal from
Wichita State University.
Signature:
Date: