Application for Employment with the Southeast Region

TroyUniversity – UniversityCollege

Application for Employment with the Southeast Region

81 Beal Parkway

Fort Walton Beach, FL 32548-5327

PERSONAL DATA

Name:
Last / First / Middle
Address:
Telephone: / ( ) / ( )
Area Code Home Phone / Area Code / Other Phone
Email:
Social Security Number:
Indicate position for which you are applying:
EMPLOYMENT HISTORY
List in order beginning with current or most recent employment. Attach pates if necessary.
A separate employment history may be attached in lieu of completing this section.
May we contact your employer? / ______/ Yes / ______/ No
Employer (Name and Address) / Employed (Mo/Yr)
From:
To: / Salary
Start / End
Telephone / Supervisor / Your Job Title
Duties
Reason for leaving
May we contact this employer? / ______/ Yes / ______/ No
Employer (Name and Address) / Employed (Mo/Yr)
From:
To: / Salary
Start / End
Telephone / Supervisor / Your Job Title
Duties
Reason for leaving
May we contact this employer? / ______/ Yes / ______/ No
Employer (Name and Address) / Employed (Mo/Yr)
From:
To: / Salary
Start / End
Telephone / Supervisor / Your Job Title
Duties
Reason for leaving

TROY Publications 116-093

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May we contact this employer? / ______/ Yes / ______/ No
Employer (Name and Address) / Employed (Mo/Yr)
From:
To: / Salary
Start / End
Telephone / Supervisor / Your Job Title
Duties
Reason for leaving

EDUCATIONAL DATA

School Name / Address, City, State, Zip / Years Completed / Degree, Major, or Type of Course Work
College/University
Graduate
Graduate
Other

GENERAL INFORMATION

Have you ever been convicted of a criminal offense? / Yes / No
(A conviction will not necessarily result in the denial of employment)
If yes, please describe:
Have you previously applied for employment with the Troy University System?
Yes / No / If yes, what position
Have you previously been employed by the Troy University System or its affiliates?
Yes / No / If yes, when and where:
Are you related to anyone currently employed by the Troy University System?
Yes / No / If yes, who:

AGREEMENT (Please read the following statements carefully)

I hereby affirm that the information provided on this application (and submitted resume, if any) is true and complete to the best of my knowledge.

I authorize the Troy University System to inquire, as deemed necessary, of information pertaining to my previous employment, education, criminal background, credit history, and any other job related information.

SignatureDate

The Troy University System is an AA/EEO/ADA employer and encourages applicants from

individuals with disabilities, females, African Americans and other minorities.

TROY Publications 116-093

1