mscu employment application 5-1-10

8/13/2019 MSCU Employment Application 5-1-10

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EMPLOYMENT APPLICATIONPLEASE DO NOT WRITE IN SHADED AREAS FOR OFFICE USE ONLY

PLEASE PRINT

Name: Todays Date:

Address:

Phone: Alt. Phone:

Email: ExpectedWage/Salary:

$ per

Position Applying for:

o! did yo" hear a#o"tthis position$

PLEASE PLACE A CHECK BY YOUR RESPONSE OR PROVIDE THE APPROPRIATE INFORMATION.a%e yo" e%er #een con%icted of a felony& con%icted of a misdemeanor in%ol%ing dishonesty or moral t"rpit"de&or con%icted in a military co"rt martial$ 'A con%iction !ill not a"tomatically #ar yo" from employment

(ES N)

*f yes& please explain:

Are yo" legally eligi#le to !or+ in this co"ntry$

(ES N)

,an yo" !or+ at locations not accessi#le #y p"#lic transportation$

(ES N)a%e yo" e%er #een declined for #ond co%erage$

(ES N)a%e yo" e%er had any #ond co%erage modified or re%o+ed$

(ES N)

IN ADDITION TO ATTACHING YOUR RESUME, please list !"# $!#% e&pe#ie'(e )el!$ *last +!) i#st-

,)-PAN( NA-E AND),AT*)N

P)S*T*)N/DT*ES SAA0(/WA1E DATES E-P)(ED 0EAS)N 2)0EA3*N1

SPE03*S)0/T*TP)NE N-4E020)-:

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Spe(ialie/ S%ills *S%ills0E1"ip2e't Ope#ate/ 3 #s e&pe#ie'(e- PC/MAC ________ Word________ Excel ________ PowerPo!" _______ O#"loo ______

State a' a//iti!'al i'!#2ati!' !" eel 2a )e 4elp"l t! "s i' (!'si/e#i'5 !"# appli(ati!'6

MSCU is a' E1"al Opp!#t"'it E2pl!e#

0EE3ANT ED,AT*)N '*ST TW) *1EST5:

,)E1E/S,)) 6 ),AT*)N -A7)0 DE10EE/D*P)-A0E,E*3ED

)TE0 ED,AT*)NA *N2)0-AT*)N& Professional ,ertificationAffiliations and/or icenses 'indicate State and Date's5 ifapplica#le5

7.

8.

9.

PERSONAL REFERENCES

*please list 'a2e, a//#ess, p4!'e '"2)e#, ea#s ! a(1"ai'ta'(e a'/ p#!essi!'-

Na2e

7.

A//#ess P4!'e N"2)e#*s- P#!essi!' Title Yea#s !

A(1"ai'ta'(

8.

9.

CERTIFICATE OF CANDIDATE %To &e Co'(le"ed &) All C*!dd*"e+,

-e!er*l. I *0e +#1'""ed "e *""*ced 2or' "o MSCU 2or "e (#r(o+e o2 o1"*!!3 e'(lo)'e!"4 I cer"2) *+ "o "e *cc#r*c) o2 "e '*""er+ +e" 2or" ere! *!d ! ') re+#'e *!d#!der+"*!d "*" *!) '++"*"e'e!" o2 2*c" '*) c*#+e 'e "o 1e re2#+ed e'(lo)'e!" or "o lo+e ') e'(lo)'e!"4 I2 e'(lo)ed5 I 2#r"er #!der+"*!d "*" ') e'(lo)'e!" + !o" 3#*r*!"ee

2or *!) +(ec2c "'e *!d '*) 1e "er'!*"ed *" *!) "'e 2or *!) re*+o!4

Re2ere!ce+. I ere1) *#"or6e MSCU *!d "+ *3e!"+ "o '*e +#c !0e+"3*"o!+ *!d !7#re+ !"o ') e'(lo)'e!" *!d ed#c*"o!*l +"or) *!d o"er rel*"ed '*""er+ *+ '*) 1e!ece++*r) ! *rr0!3 *" *! e'(lo)'e!" dec+o!4 I ere1) rele*+e e'(lo)er+5 +cool+5 *!d o"er (er+o!+ 2ro' *ll l*1l") ! re+(o!d!3 "o !7#re+ co!!ec"ed w" ') *((lc*"o! *!d+(ec2c*ll) *#"or6e "e rele*+e o2 !2or'*"o! 1) *!) +cool+5 1#+!e++e+5 !d0d#*l+5 +er0ce+ or o"er e!""e+ l+"ed 1) 'e ! "+ 2or'4

I! Co!!ec"c#"5 e22ec"0e Oc"o1er 85 9::95 *! e'(lo)'e!" *((lc*"o! 2or' "*" co!"*!+ *!) 7#e+"o! co!cer!!3 "e cr'!*l +"or) o2 "e *((lc*!" '#+" co!"*! * !o"ce5 ! cle*r *co!+(c#o#+ l*!3#*3e .4 "*" "e *((lc*!" + !o" re7#red "o d+clo+e "e ex+"e!ce o2 *!) *rre+"5 cr'!*l c*r3e or co!0c"o!5 "e record+ o2 wc *0e 1ee! er*+ed (#r+#*!" "o +ec"o! ;


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AUTHORI:ATION TO RELEASE INFORMATION

I5L*+" N*'e Fr+" N*'e Mddle N*'e

C#rre!" Addre++ D*"e+ L0ed

Here

Addre++e+ 2or "e P*+" Se0e! Ye*r+. %!cl#de +"ree"5 c")5 +"*"e5 6( code, D*"e+ o2 Re+de!ce.

D*"e o2 &r" O"er N*'e+ U+ed %!cl#d!3 '*de! !*'e, Ye*r+ U+ed

Soc*l Sec#r") N#'1er Dr0erB+ Lce!+e S"*"e

do ere1) *#"or6e 0er2c*"o! o2 *ll !2or'*"o! ! ') e'(lo)'e!" *((lc*"o! 2ro' *ll +o#rce+ o2 e'(lo)'e!"5 ed#c*"o!5 'o"or0ecle5 2!*!c*l +"or)5 cr'!*l +"or)5 (er+o!*l c*r*c"er5 cred" *!d worerB+ co'(e!+*"o! record+ ! *ccord*!ce w" ADA5 l*1or*!d w*3e record+ *!d "e F*r Cred" Re(or"!3 Ac"5 e"c4 or *!) (*r" "ereo25 *!d *#"or6e *!) d#l) *#"or6ed *3e!" o2 M"t"alSe("#it C#e/it U'i!' "o o1"*!5 we"er "e +*d record+ *re (#1lc or (r0*"e5 *!d !cl#d!3 "o+e wc '*) 1e dee'ed "o 1e

(r0le3ed or co!2de!"*l ! !*"#re *!d I rele*+e *ll (er+o!+ 2ro' l*1l") o! *cco#!" o2 +#c d+clo+#re+4 I!2or'*"o! *((e*r!3 o! "+A#"or6*"o! wll 1e #+ed excl#+0el) 1) M"t"al Se("#it C#e/it U'i!'2or de!"2c*"o! (#r(o+e+ *!d 2or "e rele*+e !2or'*"o!wc wll 1e co!+dered ! de"er'!!3 *!) +#"*1l") 2or e'(lo)'e!"4 I cer"2) "*" I *0e '*de "r#e5 correc"5 *!d co'(le"e *!+wer+*!d +"*"e'e!"+ o! ') e'(lo)'e!" *((lc*"o!5 *!) +#((le'e!"+ "o " *!d ! *!) !"er0ew ! "e !owled3e "*" "e) wll 1e reled #(o!! co!+der!3 ') *((lc*"o! 2or e'(lo)'e!"4 I *3ree "o (ro0de *dd"o!*l !2or'*"o! "*" '*) 1e re7#e+"ed "o (roce++ ')e'(lo)'e!" *((lc*"o!4 I *#"or6e w"o#" re+er0*"o!5 *!) (*r") or *3e!c) co!"*c"ed 1) M"t"al Se("#it C#e/it U'i!'"o 2#r!+ "e*1o0e='e!"o!ed !2or'*"o!4 T+ *#"or6*"o! + 0*ld d#r!3 "e co#r+e o2 ') e'(lo)'e!" "o "e ex"e!" (er'""ed 1) l*w4

I ere1) do _______do !o"_________ *#"or6e )o# "o co!"*c" my currente'(lo)er 2or E'(lo)'e!" *!d Re2ere!ce er2c*"o!+%T+ wll *#"or6e ''ed*"e !7#re+ "o "e H#'*! Re+o#rce+ De(*r"'e!" *!d "o *!) l+"ed +#(er0+or+ or re2ere!ce+ ! "eE'(lo)'e!"/Re2ere!ce Sec"o! o2 )o#r *((lc*"o!4,

I *0e "e r3" "o '*e * re7#e+" "oM"t"al Se("#it C#e/it U'i!'5 #(o! (ro(er de!"2c*"o!5 "o re7#e+" "e !*"#re *!d +#1+"*!ce o2*ll !2or'*"o! ! "+ 2le+ o! 'e *" "e "'e o2 ') re7#e+"5 !cl#d!3 +o#rce+ o2 !2or'*"o!5 *!d "e rec(e!"+ o2 *!) re(or"+ o! 'ewc M"t"al Se("#it C#e/it U'i!'*+ (re0o#+l) 2#r!+ed w"! "e "wo )e*r (erod (reced!3 ') re7#e+"4

I #!der+"*!d *!d *3ree "*" *!) o'++o!5 2*l+e +"*"e'e!"5 '+le*d!3 +"*"e'e!"5 or *!+wer '*de 1) 'e o! ') *((lc*"o! or *!)+#((le'e!"+ "o " *!d ! *!) !"er0ew+ wll 1e +#22ce!" 3ro#!d+ 2or reec"o! o2 e'(lo)'e!" *!d ') d+c*r3e *2"er e'(lo)'e!"4

________________________________________ _______________Pr!"ed N*'e A((lc*!" S3!*"#re D*"e

CALIFORNIA, OKLAHOMA, a'/ MINNESOTA RESIDENTS ONLY6 I !" a#e a ("##e't Cali!#'ia, O%la4!2a, !#Mi''es!ta #esi/e't a'/ $!"l/ li%e t! #e1"est a (!p ! !"# C!'s"2e# Rep!#t !# I';esti5ati;e C!'s"2e# Rep!#t, please (4e(%

t4e )!&. T4is #ep!#t2a i'(l"/e (4a#a(te# a'/ #ep"tati!' i'!#2ati!' !)tai'e/ t4#!"54 pe#s!'al i'te#;ie$s.

mscu employment application 5-1-10

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