Application for Part-Time Instructor

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Application for Part-Time Instructor

  1. 1. Application for Employment 1400 East Hanna Avenue Indianapolis, IN 46227-3697 The University of Indianapolis is an equal opportunity employer, and , as such, does not discriminate in hiring or employment on the basis of race, sex, creed, color, religion, physical challenge or national origin. Thank you for your interest in employment with the University of Indianapolis. Date of Application: __________________________ Date Available: _______________________ Name: _____________________________________________________________________________________________________________ Last First Middle Social Security Number*: ________________________________________________________________________ University of Indianapolis *1) Completion of Social Security Number is optional. 2) Failure to submit Social Security Number will not prohibit employment consideration. 3) Your Social Security Number WILL be required upon employment. <ul><li>Address: ______________________________________________________________________________________ </li></ul><ul><li>Street City State Zip Code </li></ul><ul><li>Telephone Number: ___________________________________ Other Number: ________________________ </li></ul><ul><li>Position(s) Desired: _____________________________________________________________________________ </li></ul><ul><li>Are you available to work: ________ Full Time _______ Part Time _____ Temporary </li></ul><ul><li>Wage/Salary Expected: $_________________________________________________________________________ </li></ul><ul><li>Why are you interested in employment at the University of Indianapolis? ___________________________________ </li></ul><ul><li>______________________________________________________________________________________________ </li></ul><ul><li>______________________________________________________________________________________________ </li></ul><ul><li>~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ </li></ul><ul><li>EDUCATION AND PROFESSIONAL TRAINING </li></ul><ul><li>Circle highest grade completed in school: 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 </li></ul>Academic, Vocational, Technical Training School Name and Location From To Major/Degree or Certificate Do you currently attend school? ____________ Where? __________________________________________ Do you plan to continue your education? ________ Where? __________________________________________
  2. 2. <ul><li>SPECIAL SKILLS </li></ul><ul><li>(Check applicable skills) </li></ul>Personal Computer Excel Custodial Electricity Word Processor Macintosh Plumbing Food Service Microsoft Word Typewriter – WPM: Grounds Keeper Microsoft Access Fax Machine Carpentry Other: Please state any information you feel may be helpful to us in considering your application: _________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ <ul><li>EMPLOYMENT HISTORY </li></ul><ul><li>(List most recent employment first) </li></ul>Employer Name Supervisor’s Name & Starting Ending Wage Job Position And Address Phone Number Date Date Complete the following statements: 1. If now employed, why are you considering leaving your present position? _____________________________________ ___________________________________________________________________________________________________ 2. Have you ever been discharged, refused renewal of contract, or requested to resign from a former position? ________ No ________ Yes If yes, please give details of such action: _________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ 3. May we contact the employers listed above? _____ Yes _____ No If no, please indicate which one(s) you do NOT wish us to contact and state the reasons why you prefer we not contact them: ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ 4. Have you ever been convicted of a felony? _____ No _____ Yes If yes, please explain: _________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ (Please note, your employment will be contingent upon conviction.)
  3. 3. <ul><li>REFERENCES </li></ul><ul><li>(Other than relatives) </li></ul>Name Telephone Number Address Occupation May we contact your references? _____ Yes _____ No I certify that the information found within this application has been provided voluntarily and I waive any right to assert discrimination on the basis of that which has been divulged. I authorize all persons, firms, corporations, educational institutions, and organizations of any kind to release to the University of Indianapolis any and all information, files, or records pertaining to this application, and to permit inspection, and to furnish copies of any documents pertinent to this application. I further authorize any and all persons in any capacity to answer any and all questions in any form that may be submitted to them concerning this application. This includes permission to conduct a limited criminal history check. In the event of employment, I understand that false, misleading or omission of information given in my application or interview (s) may result in discharge. Dated this ________ day of _______________________, 200___ ________________________________________ Legal Signature of Applicant WAIVER ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ DO NOT WRITE BELOW THIS LINE ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Interviewed by: _________________________________________________________ Date: ________________ _________________________________________________________ Date: ________________ Remarks: _______________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Position Offered: _____ Yes _____ No If yes, was the position accepted: _____ Yes _____ No If yes, when will the applicant start: ______________________ Starting Salary: $ _____________ per month. If no, explain: ____________________________________________________________________________________ ________________________________________________________________________________________________ Reference Name: ________________________________ Date/Time Contacted: ____________________ Comments: ______________________________________________________________________________________ ________________________________________________________________________________________________ Reference Name: ________________________________ Date/Time Contacted: ____________________ Comments: ______________________________________________________________________________________ ________________________________________________________________________________________________ Reference Name: ________________________________ Date/Time Contacted: ____________________ Comments: ______________________________________________________________________________________ ________________________________________________________________________________________________
  4. 4. C:winntprofilesslaymandesktopmyfolderhrlettersapplication.ppt

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