Employment: application for STAFF positions

Personal information

Date of application:	November 21, 2009
* Position(s) applied for:
Referral source:	Advertisement Friend Relative Employment agency Other:
* Your name:	(last, first, middle)
* E-mail address: (Just one address, please)
* Address:
* Phone number:
* Have you filed an application here before?	No Yes If so, date:
* Have you ever been employed here before?	No Yes If so, date:
* Are you available to work?	Full time Part time
* Have you been convicted of a felony?	No Yes If yes, explain:
Please read and respond at right to the college: - mission statement - core values - commitment to community standards (links will open in a new window)	* 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 you have worked for.

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:
Address:
Job title:
Supervisor:
Reason for leaving:
Dates of employment:
Starting wage:
Ending wage:
Work performed:

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 completed 12 11 10 9
Diploma or GED:	Yes No

School name:
Years completed grad/college/university:	Select years completed 4 3 2 1
College diploma:
Describe course of study:

Professional school name:
Years completed:	Select years completed 4 3 2 1
Professional diploma:
Describe course of study:

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:

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.

Agreement

I certify that answers given herein 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 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.