STUDENT UNION CALIFORNIA STATE UNIVERSITY, SAN BERNARDINO 5500 University Parkway San Bernardino, CA 92407

Transcription

1 STUDENT UNION CALIFORNIA STATE UNIVERSITY, SAN BERNARDINO 5500 University Parkway San Bernardino, CA Application for Management/Support Staff Employment An Affirmative Action, Equal Opportunity, Title IX, Rehabilitation Act of 1973 Employer Date: Position Applying For: Position #: Department: RETURN COMPLETED APPLICATION TO CSUSB HUMAN RESOURCES DEPT., 5500 UNIVERSITY PKWY., SAN BERNARDINO, CA 92407, SIERRA HALL, ROOM 110, (909) General Information (Please Type or Print) Name:, First, Initial Home Telephone (Include Area Code) Address: Number, Street, Apartment/Space Number ( ) Work Telephone (Include Area Code) ( ) City, State, Zip Code May we contact you at work? Can you submit proof of age Can you, after employment, submit verification If Selected for employment, are you willing at time of employment? of your legal right to work in the United States? to have a physical examination? If selected for employment, are Are you currently enrolled as a student If selected, how soon could you be available you willing to be fingerprinted? at CSUSB? for work? Have you worked under another name? Are you now or have you ever been employed by If yes, please state name to facilitate background check. the Student Union of CSUSB? If so, when? Do you have any relatives who are employees Name Relationship Department of the Student Union of CSUSB? Clerical/Secretarial Applicants Only: Typing Speed CWPM Shorthand Speed CWPM Other skills: Have you ever been dismissed Yes [ ] If yes, please explain. from employment? No [ ] Have you ever been convicted of a felony? If yes, please describe. A conviction will not necessarily disqualify you from employment. Have you served in the U.S. Armed Forces? Summarize experience relevant to the position for which you are applying. Current licenses or certificates held (specify kind and expiration date). For those positions which require driving, do you have a valid driver s license? If yes, please give the number: State

2 Employment Resumes may be included but this employment portion of the application must be filled in completely. List your entire work record. Begin with your present job and list in reverse order. Include self-employment in excess of one month as a separate period. List each promotion as a separate job. Please account for all work history. Attach additional sheets as necessary. Include Military or volunteer experience. MAY WE CONTACT YOUR PRESENT EMPLOYER?

3 Education Name and Address of High School Attended Major Course of Study Did you Graduate? College or University Education Number of Certificate/ Name and Address of Institution Major Years Completed Diploma/Degree List appropriate courses for this position and any other education, courses, certificates, seminars, etc. not listed above: List all your computer and software experience: Additional Qualifications Please identify any skill, knowledge or ability related to this position which would assist in the evaluation of your application.

4 References List a minimum of THREE people, not related to you, who can attest to your professional abilities and expertise. Address, City, State, Zip Address, City, State, Zip Address, City, State, Zip Code The Immigration Reform and Control Act of 1986, Public Law , requires that employers obtain documentation from every new employee which confirms identity and authorizes that individual to accept employment in this country. This requirement applies to both United States citizens and aliens. Can you provide the necessary documentation at the start of employment? YES [ ] NO [ ] This information may be used only for the purpose of employment in accordance with the Information Practices Act of I hereby certify that the information contained in this application form is true, complete and correct to the best of my knowledge and agree to have any of the statements checked by the Student Union unless I have indicated to the contrary. I authorize the individuals and/or organizations, entities or agencies described in this application to release to the Student Union any and all information concerning my previous employment (including, but not limited to, achievement, performance, attendance, etc.) and any pertinent information that they may have. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to the Student Union as well as from the use of disclosure of such information by the Student Union or any of its agents, employees, or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer or, if I am hired, may be considered cause for termination. Applicant's Signature Date

5 CALIFORNIA STATE UNIVERSITY, SAN BERNARDINO STUDENT UNION APPLICANT DATA FLOW AFFIRMATIVE ACTION (CONFIDENTIAL) Dear Applicant: California State University, San Bernardino is an Affirmative Action Employer and is required to maintain statistics on all applicants. This data is for statistical purposes only and has no bearing on applicant selection. It is maintained separately from the application for employment and is not available to hiring departments. We request your cooperation in completing this form and returning it with your application. Thank you for helping us meet our requirements. Name: Job Code: Date: Position Applied For: Sex: Female Male Veteran Status: Veteran? Yes No Vietnam Era Veteran? Yes No Disabled Veteran? Yes No If yes, describe: Ethnicity: 1. Black 3. Other Non-White 6. Pacific Islander: Hawaiian 2. Asian: 4. Hispanic: Samoan Japanese Mexican American Guamanian/ Chinese American/Chicano Chamorro Korean Puerto Rican Other Vietnamese Cuban Asian Indian Other 7. American Indian: Cambodian Laotian 5. White Aleut Other Eskimo Other (describe) 8. Filipino Do you have any condition or disability that would qualify you as a disabled person? Yes No How did you learn of this vacancy? 1. Newspaper Advertising 4. Referral: Which Publication? Friend Employee 2. Job Listing 5. Other (describe) Which agency? Hour Job Line 6. Internet sua suh