Shawnee Community College Application for Employment
Print this form, fill it out in its entirety and mail it to:
Personnel Officer, Shawnee Community College, 8364 Shawnee College Rd., Ullin, IL 62992
Phone: 1(618) 634-3200

Please Print or Type

Position: _______________________________________________________________________________________

Full Time __________ Part Time__________ Temporary__________

Date of Application__________________________ Salary Desired______________________

PERSONAL INFORMATION

________________________________________________________________
NAME            (Last)                                     (First)                        (Middle)                            

SOC. SEC. NO.______________________________

STREET ADDRESS ______________________________________________________________________________

CITY_______________________________________________________________STATE_____ZIP_____________

HOME PHONE (________)__________________ OFFICE PHONE (________)__________________

MISCELLANEOUS

Are you less than 18 years of age? (    ) Yes (    ) No.   If yes, can you furnish a work permit? (    ) Yes (    ) No.

Have you ever been employed by Shawnee Community College before? (    ) Yes (    ) No.

Have you previously filed an application with Shawnee Community College? (    ) Yes (    ) No.

Are you legally permitted to work in this country? (    ) Yes (    ) No.

If yes, will you be prepared to produce proof at the time of hire,
in accordance with the Immigration Reform Control Act of 1986?  (    ) Yes (    ) No.

Earliest date available to assume responsibilities of the position:___________________________

Have you ever been convicted of a felony? A positive will not necessarily affect your eligibility to be hired.  (    ) Yes (    ) No.

If Yes, explain:__________________________________________________________________________________________________

Can you travel if it is a job requirement?  (    ) Yes (    ) No.











EDUCATION

School Name and Address of School Dates Attended Degree/Diploma Major
High



College



College



College



Other Pertinent Formal Training, If Any:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Professional Organizations:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Academic Recognition or Awards:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

REFERENCES

List references who are not related to you and are not previous employers
Name/Position Address Telephone Number










EMPLOYMENT HISTORY List in order of last employer first.


School/Firm__________________________________________Dates of Employment_________________________

Address______________________________________________________________________________________
                        Street                                City                         State                         Zip Code                         Phone No.

Position______________________________________________________Salary____________________________

Describe duties of Position:________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Reason for Leaving_____________________________________               Voluntary_________ Involuntary________

Supervisor__________________________________                May be contacted for references (    ) Yes (    ) No


School/Firm__________________________________________Dates of Employment_________________________

Address______________________________________________________________________________________
                        Street                                City                         State                         Zip Code                         Phone No.

Position______________________________________________________Salary____________________________

Describe duties of Position:________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Reason for Leaving_____________________________________               Voluntary_________ Involuntary________

Supervisor__________________________________                May be contacted for references (    ) Yes (    ) No


School/Firm__________________________________________Dates of Employment_________________________

Address______________________________________________________________________________________
                        Street                                City                         State                         Zip Code                         Phone No.

Position______________________________________________________Salary____________________________

Describe duties of Position:________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Reason for Leaving_____________________________________               Voluntary_________ Involuntary________

Supervisor__________________________________                May be contacted for references (    ) Yes (    ) No

READ CAREFULLY

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize and agree to cooperate in a thorough investigation of all statements made herein and other matters relating to my background and qualifications. I understand that any investigation conducted may include a request for employment and educational history, credit reports, consumer reports, investigative consumer reports, driving record, and criminal history. I authorize any person, school, current and former employer, consumer reporting agency, and any other organization or agency to provide information relevant to such investigation and I hereby release all persons and coorperations requesting or supplying information pursuant to such investigation from all liability or responsibility to me for doing so. I understand that I have the right to make a written request within a reasonable period of time for complete disclosure of the nature and scope of any investigation. I further authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the job for which I am being considered or any future job in the event I am hired.
I agree to abide by all the rules and regulations in effect at the time of my employment or subsequently initiated.
I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINATE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.
I have read, understand, and by my signature consent to these statements.

Signature of applicant________________________________________________________________________Date______________

Shawnee Community College is an Equal Opportunity Affirmative Action Employer.
Women and Minorities are encouraged to apply.