Transforming Lives
Baldwin Wallace University
is an academic community
committed to the
liberal arts and sciences
as the foundation
for lifelong learning.
The University fulfills
this mission through a
rigorous academic program
that is characterized by
excellence in teaching
and learning within a
challenging, supportive
environment that enhances
students’ intellectual
and spiritual growth.
Baldwin Wallace assists
students in their preparation
to become contributing,
compassionate citizens
of an increasingly global
society and encourages
their pursuit of personal and
professional excellence.
The Mission Statement
of Baldwin Wallace University
APPLICATION
for EMPLOYMENT
NAME___________________________________________________ Soc. Sec._______/______/_______
Last First M.I.
ADDRESS________________________________________________ Telephone ____________________
Street City State Zip (Include Area Code)
In case of emergency, notify___________________________________ Work Phone___________________
Address___________________________________________________ Home Phone___________________
POSITION DESIRED: 1.______________________________ 2.______________________________
Full Time_________ Part Time__________
Part-Time Applicants: Since you have applied for part-time work, please type in the number of days
you can work, between 1 and 7:
How many hours can you work?______________________________________________________________
EDUCATION:
High School__________________________________________ Graduate? Degree/Course/Work
Address ____________________________________________ Yes___ No___ _________________
____________________________________________
College: ____________________________________________ Graduate? Degree/Course/Work
Address ____________________________________________ Yes___ No___ _________________
SPECIAL SKILLS:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Have you ever been employed at Baldwin Wallace University? Y es___ No___ If yes, please complete the
section below.
____________________________________________________ ________________ _____________
Name of Supervisor Department From / To
Are you related to a current employee of Baldwin Wallace? Yes___ No___ If yes, who?
____________________________________________________ _________________________________
Name Department
Are you authorized to accept employment in the United States? Yes___ No___ If no, please explain:
________________________________________________________________________________________
Office of Human Resources
275 Eastland Road
Berea, OH 44017-2088
Phone 440-826-2220
Fax 440-826-6976
www.bw.edu
Baldwin Wallace University is an
equal opportunity employer and
does not discriminate because of
race, creed, age, disabilities,
national origin, gender or sexual
orientation.
Cell Phone
Have you been convicted of a felony within the last ten years? Yes___ No___ If yes, please explain:
_______________________________________________________________________________________________________
EMPLOYMENT EXPERIENCE:
(List most current or present employer first.)
From Date: _______________________________________ To:________________________________________
Employer: ______________________________________________________________________________________
Phone number: ______________________________________________________________________________________
Address: ______________________________________________________________________________________
Position: ______________________________________________________________________________________
Supervisor: ______________________________________________________________________________________
Reason for leaving:______________________________________________________________________________________
From Date: _______________________________________ To:________________________________________
Employer: ______________________________________________________________________________________
Phone number: ______________________________________________________________________________________
Address: ______________________________________________________________________________________
Position: ______________________________________________________________________________________
Supervisor: ______________________________________________________________________________________
Reason for leaving:______________________________________________________________________________________
From Date: _______________________________________ To:________________________________________
Employer: ______________________________________________________________________________________
Phone number: ______________________________________________________________________________________
Address: ______________________________________________________________________________________
Position: ______________________________________________________________________________________
Supervisor: ______________________________________________________________________________________
Reason for leaving:______________________________________________________________________________________
REFERENCES:
(Do not include relatives or former employers)
Name Present Address Occupation Phone Number
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
It is understood that employment is predicated on the truthfulness of statements made in this application, including
satisfactory proof of authorization to work in the United States and a favorable report of references, all of which Baldwin
Wallace University is hereby authorized to verify. Any false statements, misrepresentations or failure to disclose significant
information on this application may result in dismissal.
_________________________________________________________ _______________________________________
Signature Date
APPLICANT NOT TO WRITE BELOW THIS LINE
Comments of Interviewers:
Rev. 6/12
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