Personal Information

*Position(s) applied for:

*How did you hear about this position?

NewspaperFriend/RelativeEmployment AgencyWebsiteOther

*Name of source:

*Your name: (last, first, middle)

*Email address:

*Address:

*Home phone number:

( ) -

*Cell phone number:

( ) -

*Work phone number:

( ) -

*Have you filed an application in the past year?

 No Yes If so, what position:

*Have you been employed here before?

 No Yes , date:

*Are you available to work?

 Full time Part time

*Have you ever been convicted of a felony?

 Yes No

If yes, explain:

Please read and respond to the college below:
(links will open in a new window)

• Mission Statement
• Core Values
• Commitment to Community Standards

*Are you willing to support the mission and core values of the college?

*Are you willing to follow the "Commitment to Community Standards?"

*What is your current church affiliation?

List professional, trade, business or civic activities and offices held.

*Give name, address and phone number of three references not related to you. Two should be people for whom you have worked.

Employment Experience

List each job held. Start with your present or last job. Include any volunteer activities. (Exclude groups which indicate race, color, religion, sex or national origin).

Employer 1

*Employer:

*Address:

*Job Title:

*Supervisor:

Reason for leaving:

*Dates of employment:

Starting wage:

Ending wage:

*Work performed:

Employer 2

Employer:

Address:

Job Title:

Supervisor:

Reason for leaving:

Dates of employment:

Starting wage:

Ending wage:

Work performed:

Employer 3

Employer:

Address:

Job Title:

Supervisor:

Reason for leaving:

Dates of employment:

Starting wage:

Ending wage:

Work performed:

Education

List schools attended:

High School

School name:

Years completed:

Select years completed9101112

Diploma or GED:

 Yes No

College/University/Graduate

School name:

Years completed:

Select years completed1234

College diploma:

Describe course of study

Professional

School name:

Years completed:

Select years completed1234

Professional diploma:

Describe course of study

Miscellaneous

Describe specialized training, apprenticeship, skills and extracurricular activities:

Current license or registration of profession:

Honors received:

State any additional information you feel may be helpful to us in considering your application:

Attach Résumé

Attach Cover Letter

Attach Other:

Qualified applicants are considered for all positions without regard to race, color, gender, national origin, age, marital status or disability. As a church-owned institution, Goshen College exercises its legal right to seek employees who support the mission and values of the college.

 I choose to I choose not to
complete the following optional affirmative action survey.

Affirmative Action Survey

Gender:

 Male Female

Check all that apply:

 African-American, Non-Hispanic American Indian or Alaskan Native Asian or Pacific Islander Hispanic White, Non-Hispanic Handicapped Vietnam Era Veteran

African-American, Non-Hispanic - A U.S. citizen having origins in any of the Black racial groups of Africa.

American Indian or Alaskan Native - A U.S. citizen having origins in any of the original people of North America and who maintains identification through tribal affiliation or community recognition.

Asian or Pacific Islander - A U.S. citizen having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa.

Hispanic - A U.S. citizen of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

White, Non-Hispanic - A U.S. citizen having origins in any of the original peoples of Europe, North Africa or the Middle East.

Handicapped - “Handicapped” means any person who (1) has a physical or mental impairment which substantially limits one or more major life activities, (2) has a record of such impairment, or (3) is regarded as having such an impairment.

Vietnam Era Veteran - Any veteran of the armed services who between Aug. 5, 1964, and May 7, 1975, served on active duty for at least 181 consecutive days or was discharged sooner because of a service-related disability.

Agreement

I certify that answers given herein, as well as all documents submitted as part of my application, are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the event of employment, I understand that false, inaccurate, or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the college.

I understand that the college, through its agents, will conduct an investigative background check on me after making a conditional offer of employment. This will include criminal and sexual offender checks for all positions, and a consumer credit report, motor vehicle record review, and verification of educational attainment for selected positions. I grant to the college and its agents permission to conduct any such investigations. I will have the opportunity to review the results and offer additional information should the background check produce information that calls the offer of employment into question.

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