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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?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
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