Fillable VRC Veterans Resource Center Student Mentor Montgomery GI (Mt. San Jacinto Community College District)

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VRC Veterans Resource Center Student Mentor Montgomery GI (Mt. San Jacinto Community College District)

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v.5.08
Veterans Resource Center
Mt. San Jacinto College
Email Application to:
Date of Application
Month
Day
Year
Veteran Student Employment Application Students must be:
Position
A separate application is required for each position. Type or print in black or blue ink.
(Required) Student ID
Title
Department
Will you work:
Part Time MV Campus SJ Campus
General Information
Last Name
First Name
Middle
Address
City
State
Zip Code
Home Phone
Message Phone
Email
Do you have the legal right to work in the
U.S.?
Are you over the age of 18?
If hired, can you furnish proof of
age?
Do you have a valid California
Driver’s License?
Yes No
Yes No
Yes No
Yes No
Have you ever been employed
by MSJC?
Dates Employed
Campus
Department
Position
Yes No
Do you have any relatives
employed by the College?
Name
Campus
Department
Relationship
Yes No
Have you ever been convicted of a criminal offense by any court?
This includes any offense where you were found guilty, pled guilty or pled nolo contendere. You may omit:
a. traffic violations for which the fine imposed was $300.00 or less;
b. conviction of misdemeanor while under the age of 18, if the record was sealed under Penal Code 1203.45; or
c. any conviction specified in the Health and Safety Code Section 11361.5 which pertains to various marijuana offenses.
Yes No
If you answer “yes”, please list the dates, places, and specific offense(s) on this form.
A conviction will not necessarily disqualify you from consideration for employment.
Education
Name of School Location
No. of Units
Completed
G.P.A.
Degree or
Diploma
Major Minor
Are you attending
school right now?
What hours?
Course of study:
Do you plan further
educational study?
If “yes”, what field and where?
Yes No
Yes No
Expected Graduation Date:
Yes No
Have you been approved and cerfified to receive benefits?
List current benefit(s) receiving::
Language Ability :
English
Speak
Read
Write
Other
Speak
Read
Write
Veterans Resource Center Student Mentor
VRC
• Montgomery GI Bill Active Duty (38 U.S.C. Chapter 30)
• Vocational Training and Rehabilitation for Veterans With Service-Connected Disabilities (38
U.S.C. Chapter 31)
• Post-Vietnam Era Veterans Educational Assistance Program (38 U.S.C. Chapter 32)
• Dependents Educational Assistance Program (38 U.S.C. Chapter 35)
• Montgomery GI Bill Selected Reserve (10 U.S.C. Chapter 1606)
• Eligible dependents under 38 U.S.C. Chapter 35 may use work-study only while training in a state.
v.5.08
List membership in professional societies and/or committees. Give state, number, and expiration date.
(You may exclude names of organizations which may reveal your race, color, religion, national origin, ancestry, or physical handicap.)
Additional information including special projects, skills, published writings, training, machines operated special interests and community activities.
(You may exclude names of organizations which may reveal your race, color, religion, national origin, ancestry, or physical handicap.)
Employment Record
List your present or most recent employer first and include U.S. Armed Forces experience and major volunteer experience. Account for all time during at least the past ten years, including periods of
unemployment. (You may exclude names or organizations, which may reveal your race, color, religion, national origin, or ancestry.)
Position Title
Start Date
End Date
Start Salary
End Salary
Employer
Type of Business
Hours Per Week
Total Yrs./Mos.
Street Address, City, State, Zip Code
Immediate Supervisor
Phone Number
Reason for Leaving
May we contact this employer?
Yes No
Duties Performed
Position Title
Start Date
End Date
Start Salary
End Salary
Employer
Type of Business
Hours Per Week
Total Yrs./Mos.
Street Address, City, State, Zip Code
Immediate Supervisor
Phone Number
Reason for Leaving
May we contact this employer?
Yes No
Duties Performed
If more space for employment record is needed, please list the information on a separate sheet of paper and attach it to this application.
Additional Comments (if any)
v.5.08
Disclosure
MSJC prohibits discrimination against or harassment of any person employed by or seeking employment with the College on the basis of race, color,
national origin, religion, sex, physical or mental disability, medical condition (cancer-related or genetic characteristics), ancestry, marital status, age,
sexual orientation, citizenship, or status as a covered veteran (special disabled veteran, Vietnam era veteran, recently separated veteran, or any other
veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized).
MSJC is an affirmative action/equal opportunity employer. MSJC undertakes affirmative action to assure equal employment opportunity for minorities
and
women, for persons with disabilities, and for special disabled veterans, Vietnam era veterans, recently separated veterans, and any other veterans who
served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized.
College policy is intended to be consistent with the provisions of applicable State and Federal laws.
Inquiries regarding the College's equal opportunity policies may be directed to:
VP of Human Resource
Mt. San Jacinto College
1499 N. State Street, San Jacinto, CA 92783
Telephone: (951) 487-3150
Campus Security and Crime Report: MSJC Campus Security and Crime Report is available at the following web site: http://www.msjc.edu/
Campu
sSafety/Pages/Crime-Statistics.aspx. The report contains a summary of crimes reported on the campus and in other designated areas during
the past three calendar years. It also contains references to College and campus policies concerned with criminal activity and security on campus.
Authorization
I certify that all statements on this application are true and complete to the best of my knowledge and belief. If
employed, I understand that any falsification of this record may be considered cause for separation.
Applicant’s Signature
Date
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VRC Veterans Resource Center Student Mentor Montgomery GI (Mt. San Jacinto Community College District)

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Completed 5 September 2020

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