Note: Fields marked with a * require an answer. Please use "N/A" for "not applicable" if necessary. Applicants may be required to complete and sign a paper application for employment upon interview.
Applying for:

Applicant Information

*First Name:
*Last Name:
Apartment/Unit #
Referred By:
Date Available:
Salary Expected:
Background in General Maintenance:
   Yes    No
Background in Electrical:
 Yes     No
U.S. Citizen:
   Yes    No
If not, are you authorized to work in the U.S.?:
 Yes     No
Languages Spoken:
*Have you ever worked for this company?:
If yes, when?:
------ To ------
*Have you ever been convicted of a felony?
(By company policy some misdemeanors may bar employment):
If yes, explain briefly:

Employment History

Company Name:
Complete Address
(w/ City, State, Zip):
Job Title:
Starting Salary:
Ending Salary:
Start Date:
End Date:
Reason for Leaving:
May we contact your previous employer for a reference?
 Yes    No

Military Service

Start Date:
End Date:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:

Applicant's Statement

Notification and Agreement

I hereby affirm that all information in this application is true and accurate to the best of my knowledge. I understand that the college can obtain criminal history record information on applicants for employment. Pursuant to the requirements of the Fair Credit Reporting Act, notice is given that a consumer report+ may be made in connection with your application for employment. I understand that any misrepresentation or falsification of this record or failure to disclose conviction for a felony or for any offense involving moral turpitude will be considered cause for dismissal.

If you are denied employment, either wholly or partly, because of information contained in a consumer report, a disclosure will be made to you of the name and address of the consumer-reporting agency making such report.

Signature below verifies you have read the above notice and understand what it means.


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