Staff Employment Application

Cowley College Web Application for Classified Staff Employment An Equal Opportunity Employer (PLEASE PRINT ALL INFORMATION REQUESTED)
Name						Date
Street
City			State			Zip Code
Telephone No.
JOB INTEREST
Position Desired
Do you wish to work:		Full Time		Part Time		Temporary
What is your minimum weekly salary requirement?					Date available for work
Do you have commitments to another employer that might affect your employment with us?						yes	no
If yes, please describe
Have you ever been dismissed or asked to resign?				yes	no
If yes, when and for what reason?
What business machines can you operate?
What other positions are you qualified for?
Have you previously applied for employment here?				yes	no	If yes, when?
Are you legally authorized to work in the United States?				yes	no
Have you ever been convicted of, or pleaded guilty or "no contest" to, any felony or criminal offense, excluding misdemeanors and traffic offenses? If yes, briefly explain (a "yes" response will not automatically disqualify you from employment).				yes	no	If yes, explanation:
EDUCATION
Name and Address for each School Listed					Years Completed	Degree, Major, or Type of Course
High School
Community College
College/ University
Other Education
REFERENCES (Not Employers or Relatives - At Least Three)
Name and Address						Occupation	Telephone



EMPLOYMENT HISTORY
List present or most recent employer first. May we contact these employers?						yes	no
Employer			Employed		Telephone
Address			From (Mo/Yr)		Supervisor's Name
			To ( Mo/Yr)		Your Job Title
Your Salary		Duties
Start	End

Reason for Leaving
Employer			Employed		Telephone
Address			From (Mo/Yr)		Supervisor's Name
			To (Mo/Yr)		Your Job Title
Your Salary		Duties
Start	End

Reason for Leaving
Employer			Employed		Telephone
Address			From (Mo/Yr)		Supervisor's Name
			To (Mo/Yr)		Your Job Title
Your Salary		Duties
Start	End

Reason for Leaving
I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date I authorize persons, schools, my current or previous employers, and other organizations named in this application (and accompanying resume, if any) to provide any relevant information that may be required to arrive at an employment decision. If offered a position with Cowley College, I consent to taking a physical examination and such future physical examinations as may be required to comply with Kansas Statutes.
APPLICANT'S SIGNATURE						DATE