Apply for Faculty Appointment, Psychological Science Program, Department of Mathematics and Sciences

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Summary
Title:Faculty Appointment, Psychological Science Program, Department of Mathematics and Sciences
ID:1302
Department:Mathematics and Sciences
Contact Information
* First Name:
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Application for Employment Rev 1
PERSONAL INFORMATION
* Do you now or will you in the future require sponsorship to work in the U.S.?:
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* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):
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* Have you ever worked for this Company before?:
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If Yes, please provide details (Where/When/Job Title):
* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?:
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If no, please explain:

EMPLOYMENT DESIRED
* When would you be available to begin work?:
* Type of employment desired:
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Part Time
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* Hourly rate/salary desired:
* Are you currently employed?:
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If so may we inquire of your present employer?:
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If presently employed, why are you considering leaving?:

EDUCATION
Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location Did you Graduate? Degree Received Subjects Studied/Major
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If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:

EMPLOYMENT HISTORY
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EMPLOYER 1

Dates Employed Employer Name & Address Employer Phone
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To:
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Yes
No
Responsibilities Reason for Leaving Salary/Hourly Rate
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End:

EMPLOYER 2

Dates Employed Employer Name & Address Employer Phone
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To:
Job Title Supervisor Name & Title May we Contact?

Yes
No
Responsibilities Reason for Leaving Salary/Hourly Rate
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End:

EMPLOYER 3

Dates Employed Employer Name & Address Employer Phone
From:

To:
Job Title Supervisor Name & Title May we Contact?

Yes
No
Responsibilities Reason for Leaving Salary/Hourly Rate
Start:

End:

AUTHORIZATION
The facts set forth in this application and any supplemental information are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If I am hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.

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Request for References
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REFERENCES Please provide three references (not relatives).

Name Relationship Phone Number Email
Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, gender identity, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.

To view the EEO Is The Law poster, please visit: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf

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