This is a two part application. Step 1: Send you resume and cover letter. Step 2: Fill out the job application. Be sure to use the same name and email address in both forms. Thank you for applying to become a part of our team. Fill out application below or Download Printable Application
Position applying for: A) PERSONAL INFORMATION Full Name Address City State Zip Home Phone Mobile/Pager/Other E-mail E-mail (Re-enter email address) B) EDUCATION Name of School City/State Dates of Attendance Major Minor Degree
Name of School City/State Dates of Attendance Major Minor Degree
Name of School City/State Dates of Attendance Major Minor Degree C) PROFESSIONAL WORK EXPERIENCE List most recent position first. Fill out completely; do not indicate “refer to resume.” All professional work experience must be listed; if necessary attach additional information. Company Name Address City State Zip Phone Supervisor Title + Phone Dates of Employment: From To Position(s) Held Beginning Salary Current Salary Your Position or Title Full Time or Part Time Nature Of Duties Reason for leaving May we contact this employer for a reference? Yes No
Company Name Address City State Zip Phone Supervisor Title + Phone Dates of Employment: From To Position(s) Held Beginning Salary Current Salary Your Position or Title Full Time or Part Time Nature Of Duties Reason for leaving May we contact this employer for a reference? Yes No
Are you legally eligible to work in the United States? Yes No Have you been convicted of a serious crime within the last five years which is substantially related to the responsibilities of the position for which you are making application or of past positions held?? Yes No If yes, Explain: Have you ever been disciplined or discharged for theft of company or public property or related offenses? Yes No If yes, Explain: Have you ever been disciplined or discharged for fighting, assault or related offenses? Yes No If yes, Explain: Have you ever been disciplined or discharged for insubordination? Yes No If yes, Explain: : Have you ever been disciplined or discharged for violating a safety rule(s)? Yes No If yes, Explain: Have you ever been disciplined or discharged for sexual harassment? Yes No If yes, Explain: D) Narrative Statements Discuss briefly those unique qualifications that you possess which would enhance your position as a potential professional employee at Carbon County Higher Education Center. Discuss what you have done in your most recent positions to implement positive changes which would relate to your field of instruction and/or professional position for which you are applying. State briefly your views on the role of a community college in relation to the public, faculty, and students it serves. E) Professional References List those individuals, except former supervisors, who are familiar with your work and/or professional credentials. Please list 4 references in the boxes below as follows: Name, Telephone, Organization, and City and State. Reference #1 Reference #2 Reference #3 Reference #4 F) Certification I hereby certify that, to the best of my knowledge and belief, the answers to the foregoing questions and statements made by me are complete and true. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize any present employer or supervisor, past employer or supervisor, college, university or other institution of learning, law enforcement agency, state agency, federal agency, private business, military branch or the National Personnel Records Center, personal references, and for other persons to give records or information they may have concerning my employment, worker’s compensation claims, criminal history, motor vehicle history, earnings history, health, character and employment records or any other information requested to CARBON COUNTY HIGHER EDUCATION CENTER. I voluntarily and knowingly unconditionally release any named or unnamed informant from any and all liability resulting from the furnishing of this information. Signature (please type your full name) Date Carbon County Higher Education Center does not discriminate on the basis of race, color, national origin, gender, age, disability, political affiliation, religion, or belief in relation to admission, treatment of students, access to programs and activities, or terms and conditions of employment.