subject_line
Employment Application - Staff/Faculty
Personal Information
First Name
*
Last Name
*
Position Applying For
*
Program Administrator
Marketing & Registrar
Faculty/Instructor
Office Assistant
Admission Representative
Accountant
Student Service Advisor
Maintenance
Technology Specialist
Clinical Instructor
Intern
Office Assistant
D.O.B
*
+
Desire Hourly Rate
*
Phone Number
*
Emergency Contact
*
Email Address
*
Home Address
*
City
*
State
*
Zip Code
*
Authorized to work in the U.S?
*
Yes
No
Convicted of any felony?
*
Yes
No
If yes, please explain.
Availability
Days Available
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Education Background
University/College/Technical School
City & State
*
Type of Diploma/Degree
University/College/Technical School
City & State
Type of Diploma/Degree
Current Licenses and Certifications
Certification name
Expiration (if applicable)
*
+
Certification name
Expiration (if applicable)
+
Employment History
PRVIOUS EMPLOYER
Company Name
Address
Start Date
+
End Date
+
Phone
Position
Salary
Supervisor/Manager
Reason for Leaving
May we contact?
*
Yes
No
PREVIOUS EMPLOYER
Company Name
Address
Start Date
+
End Date
+
Phone
Position
Salary
Supervisor/Manager
Reason for Leaving
May we contact?
Yes
No
References
Professional Reference 1
Name
Title
Email Address
Phone
Professional Reference 2
Name
Title
Email Address
Phone
Additional Skills
List any additional skills that you would like to mention.
Please submit a copy of your resume.
Instructor Availability
Days Available
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Sunday
Explain Preference(s): (For Example: Blended, Daytime or Evening)
*