Northwest Missouri State University
Application for Employment
Personal Data
Title:
Dr.
Mrs.
Ms.
Mr.
First Name:
Middle Name:
Last Name:
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Zip Code:
Country:
Primary Phone Number (000-000-0000):
Secondary Phone Number (000-000-0000):
Primary Email Address:
How would you prefer to be contacted by Northwest Missouri State University?
Primary Telephone
Secondary Telephone
Primary Email Address
Position Sought:
Minimum Salary Acceptable: $
Employment Desired:
Full-time
Part-time
Temporary
Have you worked at the University before?
Yes
No
If so, when?
List any relatives currently working at Northwest (name,name,name,etc):
Have you ever been convicted of a felony or misdemeanor?
Yes
No
If yes*, when, where and for what?
* A criminal conviction is not an absolute bar to employment but will only be considered in relationship to specific job requirements.
Are you authorized to work in the United States?
Yes
No
If employed, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986.
Education
High School:
Location:
Diploma
GED (provide official documents)
College/University:
Location:
Degree Conferred or Hours Completed:
Graduate/Other Formal Education:
Location:
Degree Conferred or Hours Completed:
Professional Training:
Skills
Computer Skills:
Special Equipment Operated:
List any other hobbies, skills, or activities you think pertain to employment at Northwest. (Exclude those indicating race, color, religion, national origin, or sex.)
Employment History (List your last three jobs, most recent first)
Job 1 -
Name of Employer:
Type of Business:
Telephone (000-000-0000)
Address:
Job Title:
Duties:
Salary:
Date Employed:
Date Left:
Reason for leaving or seeking other employment:
Supervisor's Name:
Job 2 -
Name of Employer:
Type of Business:
Telephone (000-000-0000)
Address:
Job Title:
Duties:
Salary:
Date Employed:
Date Left:
Reason for leaving or seeking other employment:
Supervisor's Name:
Job 3 -
Name of Employer:
Type of Business:
Telephone (000-000-0000)
Address:
Job Title:
Duties:
Salary:
Date Employed:
Date Left:
Reason for leaving or seeking other employment:
Supervisor's Name:
PLEASE READ CAREFULLY - By inserting my name (as written above) in the text field below, I certify that the above statements are correct. I understand that any false information (or omissions) in the application, or its supporting documents, will be sufficient grounds for refusal to hire me or termination without notice. I agree that all rules, orders, and regulations of the Board of Regents affecting my employment shall constitute a part of my appointment or employment. I further understand that Northwest Missouri State University has the right to review my education, previous employment, driving and criminal records and other background data.
Please re-type your name here (this is a proxy for your signature):
Date (MM/DD/YYYY):