Fillable Temporary Non- Instructional Application 02-19 (Butte College)

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Temporary Non- Instructional Application 02-19 (Butte College)

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P-08 Revision 1/31/19
Application for Temporary Non-Instructional Employment
Department of Human Resources
Butte-Glenn Community College District
3536 Butte Campus Drive
Oroville, California 95965-8399
(530) 895-2400 1-800-933-8322 TDD (530) 895-2817 Fax (530) 895-2836 www.butte.edu
TITLE OF POSITION:
DATE:
Please print
N OTE: An application with the words “See Resume” or similar phrase will not be accepted.
PERSONAL INFORMATION
For correspondence purposes only, please check one of the salutations: Mr. Ms. Dr.
Mailing Address
City:
State:
Zip:
Residence Address: (Please list if different from above.):
City:
State:
Zip:
Home Phone: ( )
Cell/Message Phone: ( )
Work Phone: ( )
E-mail Address: (Email address will be utilized for correspondence regarding position status.)
May we contact you at work? Yes No
EDUCATION
Did you graduate from high school or do you have a High School Equivalency Certificate or GED? Yes No
INSTITUTION
NAME & LOCATION
College / University / Trade School
Major
Minor
Total Semester
Units Completed
Type of Degree Granted
Type of Certificate
LIST ANY TRADE OR TECHNICAL LICENSES YOU HOLD :
ADDITIONAL SKILLS & QUALIFICATIONS: (include special courses, training, foreign languages , computer applications and/or machines you can operate.)
REFERENCES – Name of persons who are familiar with your previous employment experience whom we may contact if you are a finalist.
Name
Title
Business/Institution
Daytime Phone Number
P-08 Revision 1/31/19
EMPLOYMENT RECORD - Begin with your most recent employer (Please address most recent and/or relevant jobs.)
Name of Employer
Employment Dates
Your Job Title
From:
To:
Address:
City:
State:
Zip:
Employer’s Phone: ( )
Immediate Supervisor:
Supervisor’s Title:
Supervisor’s Phone: ( )
List your job duties:
Reason for leaving:
EMPLOYMENT RECORD - Begin with your most recent employer (Please address most recent and/or relevant jobs.)
Name of Employer
Employment Dates
Your Job Title
From:
To:
Address:
City:
State:
Zip:
Employer’s Phone: ( )
Immediate Supervisor:
Supervisor’s Title:
Supervisor’s Phone: ( )
List your job duties:
Reason for leaving:
EMPLOYMENT RECORD - Begin with your most recent employer (Please address most recent and/or relevant jobs.)
Name of Employer
Employment Dates
Your Job Title
From:
To:
Address:
City:
State:
Zip:
Employer’s Phone: ( )
Immediate Supervisor:
Supervisor’s Title:
Supervisor’s Phone: ( )
List your job duties:
Reason for leaving:
CURRENT EMPLOYER
If you are currently employed, may we contact your present employer? Yes No If “No”, be advised that we must contact your employer should you become a finalist for the position.
PROOF OF ELIGIBILITY
Should you be offered employment can you provide proof of eligibility to work in the U.S. at Butte College? Yes No
Do you have any relatives currently working at Butte College? Yes No
Name
Relationship
Department
I declare that the information in this application is true and complete to the best of my knowledge, and I authorize investigation of all statements herein recorded. I waive and release from all liability persons and
organizations reporting information required by this application. I certify that I do not advocate, nor am I a member of any party or organization, political or otherwise, that now advocates the overthrow of the
government of the United States or the State of California by force or violence or other unlawful means. I understand that I will be subject to forfeiture of the employment process or dismissal if any statement in this
application is found to be untrue.
Signature Date
APPLICATION MUST BE SIGNED AND DATED
The Butte-Glenn Community College District, Oroville, California, in compliance with Titles VI and VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972 (45 CFR86), and Sections 503 and 504 of the Rehabilitation Act of 1973, Titles I and II of the
American’s with Disabilities Act of 1990 does not discriminate on the basis of race, color, national origin, religion, sex, sexual orientation, or physical/mental disability or medical condition in any of its policies, procedures, or practices; nor does the District, in compliance with
the Age Discrimination in Employment Act of 1967 and Section 402 of the Vietnam Era Veterans Readjustment Act of 1974, discriminate against any employee or applicants for employment on the basis of age or because they are U.S. disabled veterans or veterans of the
Vietnam era. This nondiscrimination policy covers admissions, access, and treatment in the District’s programs and activities, and application for and treatment in District employment. In conformance with District policy and pursuant to Executive Order 11246 and 11375,
Section 503 of the Rehabilitation Act of 1973, and Section 402 of the Vietnam Era Veterans Readjustment Act of 1974, the District affirms diversity and is an equal opportunity employer.
Inquires regarding the District’s equal opportunity policies may be directed to the Equal Opportunity Officer, Administration Building, Department of Human Resources, Butte College, 3536 Butte Campus Dr, Oroville, CA 95965-8399 (Telephone 530-895-2400); Title IX
Compliance Officer, 530-895-2379; and Sections 503/504 Compliance Officer, Disabled Student Services, 530-895-3455; ADA Coordinator, 530-895-2381. In addition, inquiries may be directed to the Director of the Office of Civil Rights, Department of Labor, Washington,
D.C. 20201.
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Temporary Non- Instructional Application 02-19 (Butte College)

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Completed 23 July 2020

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