Fillable APPLICATION FOR EMPLOYMENT (Eastern Arizona College)

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APPLICATION FOR EMPLOYMENT (Eastern Arizona College)

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APPLICATION FOR EMPLOYMENT
Name
Last First Middle
Address
P.O. Box/Street City State Zip
Telephone Number ( ) - Social Security Number (last four digits only)
Position applied for
How did you learn of this position opening?
Please complete the entire application – even if supporting documentation is attached/included.
Are you eligible to work in the United States? (Proof of eligibility will be required if hired.)
Have you ever been convicted of a crime other than a minor traffic offense?
If yes, please give details. A conviction will not necessarily disqualify an applicant from the position sought.
Have you been employed by Eastern Arizona College before?
If yes, when?
Do any of your family members currently work for Eastern Arizona College?
If yes, who?
(Family members: Spouse; Child; Grandchild; Parent; Grandparent; Brother or sister, whole or half blood, and their
spouses; Spouse’s parents, siblings and children)
Do you have any experience, knowledge, skills, abilities, or qualifications that you feel would especially fit you for
work with Eastern Arizona College in the position applied for?
Revised 5/2020
Revised 5/2020
2
Name and address of company, and type of business
Phone
Name of Supervisor From: To:
Mo./Yr. Mo./Yr.
Monthly Salary Reason for leaving
Beginning Ending
Describe in detail the work you did including major responsibilities of your position:
Record of Education
Do you have a high school diploma or the equivalent?
Please list any post-secondary education or equivalent courses of study pursued:
School
Name and Address of School
Course of
Study
Check Last
Year
Completed
Did You
Graduate?
College
1
2
3
4
Yes
No
College
1
2
3
4
Yes
No
College
1
2
3
4
Yes
No
Other
1
2
3
4
Yes
No
List below all present and past employment, beginning with current or most recent employment:
3
Name and address of company, and type of business
Phone
Name of Supervisor From: To:
Mo./Yr. Mo./Yr.
Monthly Salary Reason for leaving
Beginning Ending
Describe in detail the work you did including major responsibilities of your position:
May we contact your present employer/supervisor?
May we contact your previous employers/supervisors?
Revised 5/2020
Name and address of company, and type of business
Phone
Name of Supervisor From: To:
Mo./Yr.
Mo./Yr.
Monthly Salary Reason for leaving
Beginning Ending
Describe in detail the work you did including major responsibilities of your position:
Revised 5/2020
4
Professional/Employment References – Other than those listed above
Name and Occupation
Address
Telephone Number
I certify that the information provided in this application is true and complete to the best of my knowledge. I
authorize investigation into all information contained in and statements I have made on this application as may be
necessary for reaching an employment decision. I also understand that should an employment offer be extended
to me and accepted that I will fully adhere to the policies and regulations of Eastern Arizona College. I further
understand that any employment offered is ‘at will’ as contracted and nothing said or done during the application
or interview process shall be deemed to constitute an implied employment contract.
Applicant Signature Date
AN E Q U A L O P P O R T U N I T Y / A F F I R M A T I V E A C T I O N E M P L O Y E R
Eastern Arizona College is in compliance with Titles VI and VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of
1972, and the Rehabilitation Act of 1973, and does not discriminate on the basis of race, creed, color, national origin, disability, age, or sex
in any of its policies, practices, or procedures. This includes, but is not limited to, admissions, employment, financial aid, educational
services, programs and activities
Eastern Arizona College complies with the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, 20 U.S.
Code § 1092(f) and the Higher Education Opportunity Act of 2008, by distributing an Annual Security and Fire Safety Report. The report is
intended to inform the campus community of campus safety information, Clery Act crime statistics, on-campus housing fire data and
statistics, and policies and procedures relating to sexual violence, emergency response, and other safety factors. A copy of EAC’s Annual
Security and Fire Safety Report can be found at http://www.eac.edu/About_EAC/Consumer_Information/report.pdf. Additional copies are
available at the Alumni Library (Thatcher Campus), the Learning Resource Center (Payson Campus), and the library (Gila Pueblo Campus).
A paper copy of the report will be provided upon request at EAC’s District Office, located at 615 N. Stadium Avenue, Thatcher, AZ.
A daily crime log listing all criminal and alleged criminal incidents reported to campus police/security is available on-site, during normal
business hours, at each of the campuses: EAC Police Department, located at 620 N. College Avenue, Thatcher, AZ (Thatcher Campus); Gila
Pueblo Campus Administration Office, located at 8274 Six Shooter Canyon Road, Globe, AZ (Gila Pueblo Campus); and Payson Campus
Administration Office, located at 201 N. Mud Springs Rd., Payson, AZ (Payson Campus).
A fire log containing all reported fires that occurred at any of EAC's on-campus student housing facilities is available during normal business
hours at the Housing Office, located at 900 N. College Avenue, Thatcher, AZ.
Revised 5/2020
5
Invitation to Self Identify
Name: Position Applied for:
Information for Statistical Use Only
Eastern Arizona College is an Equal Opportunity/Affirmative Action Employer and complies with all applicable federal and
state regulations. We are required to solicit the information indicated below. This information is kept for statistical reporting
and Federal EEO/AA requirements. Once received, this information will be kept confidential and separate from your
application materials. You will receive the same consideration for employment whether or not you complete this form. Your
responses are voluntary and your cooperation is appreciated. Please return this form with your application.
Ethnicity
American Indian/Alaskan Native: A person having origins in any of the original peoples of North and South America
(including Central America), and who maintains tribal affiliation or community attachment.
Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands,
Thailand, and Vietnam.
Black/African American: A person having origins in any of the black racial groups of Africa.
Hispanic/Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or
origin, regardless of race.
Native Hawaiian/Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam,
Samoa, or other Pacific Islands.
White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Two or More Races
Gender
Male
Female
Veteran Status
Special Disabled Veteran: A veteran who is entitled to compensation (or who but for the receipt of military retired
pay would be entitled to compensation) under laws administered by the Department of Veterans Affairs for a
disability: rated at 30 percent or more; or, rated at 10 or 20 percent in the case of a veteran who has been determined
under 38 U.S.C. 3106 to have a serious employment handicap; or, a person who was discharged or released from active
duty because of a service-connected disability.
Veteran of the Vietnam Era: A person who served on active duty for a period of more than 180 days, and was
discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred: in
the Republic of Vietnam between February 28, 1961, and May 7, 1975; or, between August 5, 1964, and May 7, 1975, in
all other cases; or, was discharged or released from active duty for a service-connected disability if any part of such
active duty was performed: in the Republic of Vietnam between February 28, 1961, and May 7, 1975, or between
August 5, 1964, and May 7, 1975, in all other cases.
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APPLICATION FOR EMPLOYMENT (Eastern Arizona College)

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Completed 25 July 2020

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