APPLICATION FOR EMPLOYMENT

Transcription

1 APPLICATION FOR EMPLOYMENT 955 La Paz Road Santa Barbara, CA Phone: (805) Fax: (805) To be considered for employment you must complete all five pages. Date: Position desired: (1) (2) (3) Name Last First Initial Address Street City State Zip Home Phone/Cell or Business Phone address Are you known to schools/references by another name? Yes No If yes, by what name? How did you learn about this position? Have you filed an application or been employed here before? Yes No Date(s) & Position(s) Type of employment sought? Full-Time Part-Time: Schedule Temporary: Schedule Weekends Best time for an interview? Do any of your friends or relatives work here? Yes No If yes, list name(s)/relationship(s) Can you, after employment, submit verification of your legal right to work in the United States? Yes No Have you ever been convicted of a crime? Yes No (Conviction will not necessarily disqualify an applicant from employment. Do not include marijuana related convictions more than 2 years old) If yes, please describe, including date(s), nature of the offense and disposition of case. Are you able to perform the essential functions of the position for which you are applying including regular attendance? Yes No

2 Employment Experience List positions held, starting with your current or most recent employer and account for all periods of unemployment between jobs. Finish Rate: Finish Rate: Finish Rate: Finish Rate: May we contact the employers listed above for references? Yes No If no, indicate which one(s) you do not wish us to contact and the reason: Personal References List two references you have known at least one year, excluding employers or relatives. Name Relationship to Applicant Years Acquainted Phone No. Home: Work: Home: Work:

3 List in consecutive order each school attended starting with high school. Educational Preparation Name and Location of School Major Studied Degree Received? Professional Experience List presentations, published materials, awards and professional organizations of which you are a member. (You may omit those that indicate your race, color, gender, nationality, or ethnic origin.) Skills Typing wpm Word Processing Data Entry wpm Desktop Publishing Other (Specify): List software programs in which you are proficient: Current license(s)/certification(s): List foreign languages you speak, read, and/or write fluently: Do you have any other background that you feel qualifies you for the position you are applying for? Please explain. Authorization and Agreement I authorize Westmont College to investigate my background, including all statements contained in this application and any supporting documents, in any of the following areas, based on the requirements of the job for which I am applying or for a job to which I may be promoted or reassigned in the future: employment, education, financial, medical and related areas. I hereby release all individuals, companies, corporations, schools, credit bureaus, and legal and governmental agencies from all liability in providing such information. If I am offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the United Sates. I understand that I will be required to possess and present a valid California driver s license and an acceptable driving record if my job requires me to drive in the course of my work. If hired, I agree to abide by the policies and procedures of Westmont College. I understand that if hired my employment will be what is commonly known as at will employment, and for no definite period. This means that the College or I may terminate the employment relationship for any reason, at any time. I understand and agree that the College retains the right to demote, transfer, and change my job duties and my compensation at any time with or without notice. I certify that all information on this application and any supporting documents is true and complete. I also understand that if hired, and such information is found to be false, misrepresented, or if information was omitted, it will be considered grounds for the termination of my employment if found at a later date. I understand that no supervisor or manager may alter or amend the conditions described above, and that such conditions can only be altered or amended by a written agreement signed by the President of Westmont College. Signature Date

4 Additional Questions All employees of Westmont College are part of an active community who individually and collectively are expected to fully support the College's mission and objectives. Please read the following summary of our mission and respond to the questions below. Westmont is a Christian college of liberal arts and sciences relating our entire philosophy and program to the historic, evangelical Christian faith. Our mission is to provide a quality undergraduate liberal arts program in a residential campus community that assists college men and women towards a balance of rigorous intellectual competence, healthy personal development, and strong Christian commitments. 1. Describe how your personal values would support the mission of Westmont College and why you would want to work for Westmont. 2. Which of your experiences (work, educational, personal, etc.) have best prepared you to work at Westmont, and why? 3. What job aspects are most important to you, and why? 4. Why would you consider leaving your present employment? If you need additional space, please continue on a separate sheet of paper. Westmont College does not discriminate on the basis of age, race, color, sex, national or ethnic origin, marital status, medical condition, mental or physical disability in its employment practices, except where physical fitness is a valid occupational qualification. As allowed by federal and state law, Westmont chooses to exercise religious preference in all areas that it deems appropriate for its mission. Reprinted 10/04

5 NS SN NDISCLOSURE and AUTHORIZATION TO OBTAIN INFORMATION In connection with my employment with WESTMONT COLLEGE (herein: Westmont ), I understand that prior to or at any time after my employment commences a Consumer Report may be requested for employment purposes from InfoLink Screening Services, Inc. (herein: InfoLink ) from public records including; but not limited to, Social Security number, motor vehicle operation history, Workers Compensation information and criminal history to the extent permitted by law from various local, state, and federal agencies. In addition, in view of Westmont s responsibility to protect persons at risk, at the sole discretion of Westmont, I understand the information sought may include a search of the Sexual Offender Identification Line. Further, I understand that an Experian Employment Insight Report, Trans Union Pre-Employment Evaluation Report or Equifax Credit Report for Employment may be requested. Further, I understand that an Investigative Consumer Report may be requested and, as required under 1681d(a)(1), I understand that this Report will include information as to my character, general reputation, personal characteristics, mode of living, work habits, performance, experience, along with reasons for termination of past employment, whichever are applicable, obtained through personal interviews with associates who have knowledge concerning such items of information. I VOLUNTARILY AND KNOWINGLY AUTHORIZE ANY PRESENT OR PAST EMPLOYER OR SUPERVISOR; COLLEGE OR UNIVERSITY OR OTHER INSTITUTION OF LEARNING; ADMINISTRATOR; LAW ENFORCEMENT AGENCY, STATE AGENCY, LOCAL AGENCY, FEDERAL AGENCY; CREDIT BUREAU; COLLECTION AGENCY; PRIVATE BUSINESS; MILITARY BRANCH OR THE NATIONAL PERSONNEL RECORDS CENTER; PERSONAL REFERENCE; AND/OR OTHER PERSONS TO GIVE RECORDS OR INFORMATION THEY MAY HAVE CONCERNING MY CRIMINAL HISTORY, MOTOR VEHICLE HISTORY, SOCIAL SECURITY NUMBER, EARNINGS HISTORY, CHARACTER, AND EMPLOYMENT (INCLUDING REASONS FOR TERMINATION) OR ANY OTHER INFORMATION REQUESTED BY INFOLINK. I understand that I have the right to request a complete and accurate disclosure of the nature and scope of the investigation requested. Further, I am entitled to know if employment is denied because of information obtained by my prospective employer from a Reporting Agency. If so, I will be so advised in writing and be given the name and address of the agency, a statement that the action was based in whole or in part on information contained in the Report, and written notice that I have the right (i) if I request, to obtain within sixty days a free copy of the Report from the Reporting Agency, and from any other consumer credit Reporting Agency which compiles and maintains files on consumers on a nationwide basis; and, (ii) to dispute the accuracy or completeness of any information in a consumer credit report furnished by the Reporting Agency. I understand that upon my request with reasonable notice, InfoLink will supply me with investigative information in my file during normal business hours in person or upon written request, by mail or telephone as permitted by law. I understand that InfoLink is a consumer reporting agency and it is InfoLink s policy to not be involved in, or make, hiring decisions or recommendations. InfoLink s privacy policy limits the information it provides to the Subscriber named herein, however I hereby authorize the Subscriber to share such information with parties in interest who have a need to know such information to protect them and their employees. Such information may include names and dates of other Subscriber inquiries to InfoLink. InfoLink does not sell or otherwise provide any of the information found in its background investigations to any other party. I understand that any Consumer Report or Investigative Consumer Report requested will be used strictly for employment purposes as defined under 603(h) and authorized under 604(a)(3)(B) of the Fair Credit Reporting Act, as a report to be used for the purpose of evaluation for employment, promotion, reassignment or retention as an employee. I further understand that request for workers compensation information shall be after a conditional job offer is made and may include any and all injuries pursuant to state law and in compliance with the Federal Americans with Disabilities Act. In addition, any offer of employment, promotion, or reassignment will be conditional upon the receipt of satisfactory information as required and that to be considered for employment, promotion, or reassignment, I must authorize the procurement of such Report(s). A photographic or faxed copy of this form shall be as valid as the original. **************************************************************************************************************************************************************** The following must be filled out completely and signed for your application to be considered (Please print) LAST NAME FIRST NAME MIDDLE NAME/INITIAL HOME ADDRESS CITY COUNTY STATE ZIP SOCIAL SECURITY NUMBER DRIVER'S LICENSE NUMBER STATE ISSUED FOR IDENTIFICATION PURPOSES, PLEASE PROVIDE: MONTH OF BIRTH (Jan-Dec) DAY of MONTH BORN (1-31) [PLEASE DO NOT SUPPLY YEAR OF BIRTH!] HAVE YOU USED ANY NAMES OR SOCIAL SECURITY NUMBERS OTHER THAN ABOVE? Yes No Please List Other Names Used Please List Other SS Number Used (Please sign) TODAY'S DATE Signature Authorizing the Procurement of the Consumer Report and/or Investigative Consumer Report I understand that in California, Minnesota, or Oklahoma if a Consumer Report/Investigative Consumer Report (including any Credit Report) was requested, I may order a copy of such report and it will be mailed to me immediately: Yes, please send me a copy of my Report 9201 Oakdale Avenue, Suite 100, Chatsworth, CA PHN: (818) 990-HIRE (800) 990-HIRE FAX: (818) InfoLink All Rights Reserved (EDU3438)