Form 64 Rev 05-07
UNIVERSITY OF HAWAI=I
EMPLOYMENT APPLICATION FORM
Administrative, Professional and Technical Positions
This form is used to provide information about you relative to the position(s) for which you are applying.
This completed form and a comprehensive resume, must both be submitted in accordance with the
filing requirements specified in the advertisement. (See Suggested Resume Format
- PDF Format).
Position Title:
Position No.:
Name: Last First Middle Initial
Home Address: Street Apt. # City State Zip Code
Home Telephone: Business Telephone:
Email Address:
If selected, all individuals must present documentary evidence to verify their eligibility to work, pursuant to the Immigration Reform
and Control Act of 1986.
Employment Status: Complete the following if you are presently or formerly employed by the University of Hawai=i:
Department:
College:
Official Position Title:
Campus Phone No.:
Present or Last Appointment Period (if applicable):
FTE:
BU:
Check one of the following boxes if you are exercising employment rights in accordance with Article 10, BU 8 collective bargaining
agreement (eligibility subject to verification by the hiring unit):
“ I am being/have been relieved or terminated because of a lack of work or other legitimate reasons and have reemployment
rights as outlined in Article 9, Employment Security.
“ I am currently in the bargaining unit.
Non-Discrimination and Affirmative Action Information: The University of Hawai>i is an equal opportunity/affirmative action
institution and is committed to a policy of nondiscrimination on the basis of race, sex, age, religion, color, national origin, ancestry,
disability, marital status, sexual orientation, status as a protected veteran, National Guard participation, breastfeeding, and
arrest/court record (except as permissible under State law).
CLERY ACT: In accordance with the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, annual
campus crime statistics for the University of Hawai‘i may be viewed at: http://ope.ed.gov/security/
, or a paper copy may be obtained
upon request from the respective UH Campus Security or Administrative Services Office.
I hereby certify that all statements in this application are true and correct to the best of my knowledge, and I agree and understand that
any misstatements of material facts herein may cause forfeiture of all rights to any employment with the University of Hawai’i. I also
understand that, if selected, I must present documentary evidence to verify my employment eligibility, pursuant to the Immigration
Reform and Control Act of 1986. For electronic submissions, original signatures required prior to interview.
_______________________________________________ ______________________
Signature Date
NOTE: Attach/Submit a comprehensive resume and include: 1) your name, current address, phone number(s); 2) work history - provide sufficient
detailed information with which to determine your qualifications for the position for which you are applying, list all employment in last 10 years beginning
with most recent employment and other pertinent employment beyond 10 years; 3) education - chronologically list all higher education institutions
attended beyond Grade 12, including name, address, major field of study degree/diploma/certificate & date received; 4) relevant experience -
chronologically list pertinent military, professional, trade, technical, etc., courses you have completed, including institution name, address, subject area,
certificate & date received; 5) publications/research/other professional activities (if applicable to position) - include co-authors, title of
journal/publication & date, if book, publication date & publisher; 6) knowledge of language other than English if required for position - identify
language and include ability to read, write, converse; and 7) pertinent professional memberships and awards - list, as appropriate, membership in
professional or scientific societies, honors, awards, fellowships, etc; 8) references - provide complete contact information, as required by position
advertisement. See Suggested Resume Format
- PDF format.
An Equal Opportunity/Affirmative Action Institution
