Supervisor Salary
Resume:
Application for Employment
Dubuque, IA 52001-3198
We are an Equal Opportunity Employer
Date:
Please print in ink. You must complete the entire application.
Applicant Information
Name (first,middle, last) Day Telephone/ Evening Telephone
Address Email Address
City, State, Zip Code Social Security #
Are there other names under which you have worked or attended school? ___ Yes ___ No
If yes, please list for reference checking purposes.
___ Yes ___ No
Are you legally authorized to work in the U.S.?
(If hired, you will be required to provide proof of work authorization.)
Yes No
Are you at least 18 years old?
If not, your employment will be subject to verification that you meet state/ federal minimum age
requirements for the type of work you are applying for and have obtained a valid work permit.
Have you ever been convicted of a crime or pleaded no contest for any offense or violation other than
minor traffic violations? ___ Yes ___ No
If yes, explain 1) nature of crime, 2) date of conviction, and 3) state in which convicted.
(Convictions are not an automatic bar to employment.)
Do you have the ability to perform the essential functions of this job, with or without accomodations?
___ Yes ___ No
Have you ever applied at Clarke College before? Have you ever worked at Clarke College before?
___ Yes ___ No If yes, when: ___Yes ___ No If yes, when:
Position Applying For Part-Time or Full-Time Desired Salary Preference Shift Preference
When can you start?
How were you referred to the company? Walk-in School
Agency
Friend/Relative Newspaper Internet
Other
Special Skills
1. If relevant, please describe word processing speed, software knowledge, and office equipment experience.
2. If relevant, please describe experience in higher education.
Education
Diploma or
School Name and Location (city,state) No. Major subjects
Years Degree Recieved
Attended
High
College
Graduate
Other
(specify)
Training and Development
List any relevant training programs completed:
Content Date Completed
Course/Seminar
Employment History (start with most recent; use separate sheet if necessary)
Name of Employer Telephone Address City, State, Zip code
Job Title Employment Dates (month and year)
Name of Immediate Supervisor From: To:
May we contact as a reference?
Description of Duties Yes ___ No ___
Salary- start Salary- end Reason for leaving
Name of Employer Telephone Address City, State, Zip code
Job Title Employment Dates (month and year)
Name of Immediate Supervisor From: To:
May we contact as a reference?
Description of Duties Yes ___ No ___
Salary- start Salary- end Reason for leaving
Name of Employer Telephone Address City, State, Zip code
Job Title Employment Dates (month and year)
Name of Immediate Supervisor From: To:
May we contact as a reference?
Description of Duties Yes ___ No ___
Salary- start Salary- end Reason for leaving
Name of Employer Telephone Address City, State, Zip code
Job Title Employment Dates (month and year)
Name of Immediate Supervisor From: To:
May we contact as a reference?
Description of Duties Yes ___ No ___
Salary- start Salary- end Reason for leaving
Employment References
List individuals familiar with your job qualifications ( no relatives or personal friends).
Day Telephone Name
Evening Telephone Relationship-
Address
How long known?
Day Telephone Name
Evening Telephone Relationship-
Address
How long known?
Day Telephone Name
Evening Telephone Relationship-
Address
How long known?
Please Read Carefully Before Signing This Form
1. All information contained in this application is true and correct to the best of my knowledge and belief.
I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for
subsequent dismissal if I am hired.
2. I authorize the company the company to investigate my responses on this application and contact any or all of my
former employers or any individuals familiar with me or my employment background for the purpose of verifying
any information I have provided and/or for the purpose of obtaining any information, whether favorable or
unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person
or organization that provides information pertaining to me or my employment.
3. I understand that if offered a position at Clarke College, a background check may be required as a condition of
employment. I understand that unsatisfactory results or refusal to cooperate with pre-employment checks
may result in withdrawal of any employment offer or termination if already employed.
4. Finally, I understand that nothing is this application is intended to create an employment contract and that a job
offer is not final until all hiring conditions have been met and all required approvals have been obtained.
_____________ ____________________________ ____________________________
Date Signature Please Print Your Name
Clarke College is an Affirmative Action/Equal Opportunity Employer
In order to provide equal employment and advancement opportunities to all individuals, employment decisions at Clarke will be based
on merit, qualifications, and abilities. Clarke does not discriminate in employment opportunities or practices on the basis of race, color,
religion, sex, national origin, age, disability, sexual orientation, gender identity or any other characteristic protected by law.
Clarke College, in willing compliance with the Clery Act (Public Law 101-542) publishes annual crime statistics. This report is meant to aid
members of the college community, as well as prospective members, to understand and take appropriate measures to promote a safe learning
community at Clarke College. A complete report is available on our website - www.clarke.edu - or from the HR Office upon request.
Contact this candidate