Applicant Information
Full Name: / Date:Last / First / M.I.
Address:
Street Address / Apartment/Unit #
City / State / ZIP Code
Home Phone: / () / Cell Phone: / () / Other Phone: / ()
E-mail Address: / Date Available: / Desired Salary: / $
Have you ever worked for IALR? / YES / NO / If yes, when?
Education
High School: / City & State:Did you graduate? / YES / NO / Major: / Degree:
College: / City & State:
Did you graduate? / YES / NO / Major: / Degree:
Other: / City & State:
Did you graduate? / YES / NO / Major: / Degree:
Previous Employment
All applications must be completed in its entirety. Writing “See Resume” does not constitue a complete application. Use the Supplemental Employment Experience form for additional space.Company: / Phone: / ()
Type of Business: / Supervisor:
Street Address
City, State, Zip: / Full Time: / Part Time: / Hours Worked per week:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
Number of Employees Supervised:
Dates Employed: / From: / To:
Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO
Your name if different from your present name:
Company: / Phone: / ()
Type of Business: / Supervisor:
Street Address
City, State, Zip: / Full Time: / Part Time: / Hours Worked per week:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
Number of Employees Supervised:
Dates Employed: / From: / To:
Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO
Your name if different from your present name:
Company: / Phone: / ()
Type of Business: / Supervisor:
Street Address
City, State, Zip: / Full Time: / Part Time: / Hours Worked per week:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
Number of Employees Supervised:
Dates Employed: / From: / To:
Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO
Your name if different from your present name:
Company: / Phone: / ()
Type of Business: / Supervisor:
Street Address
City, State, Zip: / Full Time: / Part Time: / Hours Worked per week:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
Number of Employees Supervised:
Dates Employed: / From: / To:
Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO
Your name if different from your present name:
References
Please list three professional references.Full Name: / Relationship:
Street Address
City, State, Zip: / Phone: / () / Email Address:
Full Name: / Relationship:
Street Address
City, State, Zip: / Phone: / () / Email Address:
Full Name: / Relationship:
Street Address
City, State, Zip: / Phone: / () / Email Address:
Miscellaneous
1.Are you willing to accept employment, which requires you to travel?
Yes
/No
/If yes, how often are you willing to travel?
/0% - 10%
11% - 25%
26% - 49%
50% or greater
2.For purposes of compliance with The Immigration Reform and Control Act, are you legally eligible for employment in the United States? Yes No
Under the Immigration Reform and Control Act of 1986, you will be required to provide documentation verifying your identity and your eligibility for employment.3.Have you ever been convicted* for any violation(s) of law, including moving traffic violations?
Yes No / If yes, describe the offense as indicated below.
Description of Offense(s): / Date of Conviction: / County, City, State of Conviction:
Military Service
Branch: / From: / To:Rank at Discharge: / Type of Discharge:
If other than honorable, explain:
Disclaimer and Signature
By checking this box and typing my name in the space below, I hereby certify that all entries on this document and attachments are true and complete. I understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture of employment with IALR. I understand that all information on this application is subject to verification and I consent to background checks including criminal history and drug screening. I also consent to reference checks of professional references, former employers, and educational institutions. I further authorize the IALR to rely upon and use any information received from such contacts in making a hiring decision.Signature: / Date:
Supplemental Employment Experience
Company: / Phone: / ()Type of Business: / Supervisor:
Street Address
City, State, Zip: / Full Time: / Part Time: / Hours Worked per week:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
Number of Employees Supervised:
Dates Employed: / From: / To:
Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO
Your name if different from your present name:
Company: / Phone: / ()
Type of Business: / Supervisor:
Street Address
City, State, Zip: / Full Time: / Part Time: / Hours Worked per week:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
Number of Employees Supervised:
Dates Employed: / From: / To:
Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO
Your name if different from your present name:
Company: / Phone: / ()
Type of Business: / Supervisor:
Street Address
City, State, Zip: / Full Time: / Part Time: / Hours Worked per week:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
Number of Employees Supervised:
Dates Employed: / From: / To:
Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO
Your name if different from your present name:
Company: / Phone: / ()
Type of Business: / Supervisor:
Street Address
City, State, Zip: / Full Time: / Part Time: / Hours Worked per week:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
Number of Employees Supervised:
Dates Employed: / From: / To:
Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO
Your name if different from your present name: