ALFREDUNIVERSITY

Application for Employment

Please print or type Date

Name
Phone / Alt. Phone or email address
Permanent Address
Street City/State/Zip
Position(s) applied for / Salary desired
Status desired: Regular FT PT: hrs week / Temporary: # Weeks
Are you willing to work weekends or evenings? / When are you available to start work?
Are you legally authorized to work in the U.S.? Yes No (if yes, verification is required upon hire)
Are you under 18 years of age? Yes No (if yes, work permit required)
Were you previously employed by AU? Yes No If yes, dates/position held/reason for separation
List any relatives presently working for AU
How did you learn of this position vacancy?

E D U C A T I O N

School

name /address

/

Degree

earned / date

/ Major/Minor,

relevant courses / subjects

High School
or GED
College/University
College/University
Vocational School
Military Service or
Experience

Other training, education and special skills relevant to the position applied for:

EMPLOYMENT EXPERIENCE

List present or most recent employer first. Complete this section, do not note “see resume”

1. Employer Name/Address/Tel #
Date Employed From / To / Salary / hr annual
Job title and responsibilities
Supervisor’s Name / Title
May we contact him/her yes no / Reason for Leaving
2. Employer Name/Address/Tel #
Date Employed From / To / Salary / hr annual
Job title and responsibilities
Supervisor’s Name / Title
May we contact him/her yes no / Reason for Leaving
3. Employer Name/Address/Tel #
Date Employed From / To / Salary / hr annual
Job title and responsibilities
Supervisor’s Name / Title
May we contact him/her yes no / Reason for Leaving

R E F E R E N C E S

List 3 references, including the name(s)/addresses of a previous supervisor (Do NOT include relatives.)

1. Name / Address / Telephone # / Relationship
2. Name / Address/ Telephone # / Relationship
3.Name / Address/ Telephone # / Relationship

I hereby give permission to Alfred University and their agents to contact the references and employers listed above concerning my prior work experience, character and to perform any other checks as deemed necessary by Alfred University. I hereby certify that all the information given in this application and attached documents is complete, factual and truthful, to the best of my knowledge, and understand that falsification, omissions or misinformation I give may be grounds immediate discontinuation of consideration for employment or immediate termination of employment, if hired.I understand that this employment application is not a contract and that if hired, employment is at-will. Both I and AlfredUniversity are free to end my employment at any time for any reason.

APPLICANT SIGNATUREDATE