Career Services
2. Employer: __________________________________________ Employment Dates ____ / ____ through ____ / ____
mm / yy mm / yy
Position Title: ___________________________________________________________________________________
Description of Duties: _____________________________________________________________________________
3. Employer: __________________________________________ Employment Dates ____ / ____ through ____ / ____
mm / yy mm / yy
Position Title: ___________________________________________________________________________________
Description of Duties: _____________________________________________________________________________
References
1. Name: _____________________________________________ Phone Number: _______________________________
Relationship to Applicant (No relatives please): _______________________________________________________
2. Name: _____________________________________________ Phone Number: ______________________________
Relationship to Applicant (No relatives please): _______________________________________________________
Other Information
Have you ever been employed by Clark State before? Yes No
If yes, give dates and department(s): __________________________________________________________________
Have you ever been convicted of or plead guilty to a misdemeanor or felony? Yes No
If yes, you must explain the details of the oense to the Career Services Specialist before being considered for a position.
A conviction will not necessarily be a bar to employment. Each instance will be considered in relation to the position for which you apply.
Acknowledgement
By e-signing below, I certify that all the information provide in this application is true and I have not knowingly
withheld any facts that might aect the College’s decision to hire me or maintain my employment.
I also acknowledge that I understand the following:
• I must be registered for at least six credit hours at Clark State Community College and must be at least16 years old to
be eligible for on-campus employment.
• Completing an application does not guarantee an oer of employment.
• In the event that I am employed by Clark State Community College, I will be required to show proof of eligibility for
employment in the United States.
• As an employee of Clark State Community College, I am required to abide by all College policies and procedures.
• Any false or misleading information given in my application or interview(s) may result in my being discharged.
• After being extended an oer to work at Clark State Community College, a background check may be required prior
to employment.
• All Positions end at the end of Summer Semester and oces will re-evaluate stang needs at that time.
E-Signature: ____________________________________________________________ Date:
_____________________
It is your responsibility to contact Career Services if you are no longer interested in on-campus employment.
Otherwise we will continue to circulate your application for available positions throughout the semester. An updated
application and contact information form is required each semester if you are still interested in employment at
Clark State Community College. Consult with the Financial Aid Oce to determine how work-study will aect your
financial aid award.
QUESTIONS?
Contact Career Services: 937.328.6472 | careers@clarkstate.edu
Career Services does not make hiring decisions for most positions.
Qualified applicants are forwarded to work-study supervisors, who make hiring decisions for their own departments.
