MINNESOTA STATE COLLEGES & UNIVERSITIES
PRIOR WORK EXPERIENCE COLLECTION FORM FOR UNIVERSITY FACULTY
Name:_______________________________________________ Appointment Status:______________________________________
Department/Program:__________________________________ Highest Degree:_________________ Date Received:____________
Academic Rank:________________________________________
Note: The information on this form is used to calculate your potential base salary. All information must be included, and all information must
be true and accurate. The University cannot adjust your base salary in the future based on incomplete or inaccurate information.
COLLEGIATE EXPERIENCE
Please provide information regarding service in collegiate teaching, paid academic research, paid post-doctoral research, and academic administration experience prior to
hiring. This includes all sabbatical leave periods and conscripted military service from such institutions, and all academic administration and/or university approved
research experience. Do not include graduate assistantships, teaching assistantships, research assistantships, or other work related to your area of study undertaken at
or for an institution while you were a graduate student. All fields must be completed for each entry.
Attach additional sheets if necessary.
Years in Rank: Actual
Job Title/Teaching Discipline: Academic Rank: Institution: Begin End Percent of Years of
Mo/Yr Mo/Yr Full-Time: Experience:
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Total Collegiate Experience (to be completed by campus—list actual years): ____________
