For Human Resources use only: Applicant I.D. # ______PositionRecruitment # (hired into) ______

TO APPLICANT: We appreciate your interest in Metro and assure you that we are sincerely interested in your qualifications. Your cooperation in providing a clear understanding of your background and work history will aid us in considering you for a position that best meets your qualifications. It is important to be complete and accurate since the information is used to determine who is interviewed and to determine starting pay.The College is an Equal Opportunity Employer. None of the information disclosed on this application will be used by the College in an unlawful, discriminatory manner or purpose. If you need an accommodation in order to complete the application processor take any required tests, such assistance is available at the College’s Human Resources Office upon request.

Date
Positiondesired / Recruitment# (if known)
Where did you hear about the position for which you have applied?
Desired hourly wage or annual salary / $ / On what date will you be available to work?
Location(s) Preferred Fort Omaha South Omaha Sarpy Center/Offutt
Correctional Center Elkhorn Valley Fremont Center
PERSONAL INFORMATION / Social Security Number
Name
Last / First / Middle
Address
Number / Street / City / State / Zip
E-Mail Address (optional)
Phone you can be contacted at, during Day / ( ) / Evening / ( )
Area Code / Number / Area Code / Number
Have you ever worked under another name? Yes No If “Yes” state name and place of employment.
Are you at least 16 years of age? Yes No
Are you legally eligible for employment in this country? Yes No
(Proof of U.S. citizenship or immigration status will be required upon hiring, as required by the Immigration Reform and Control Act of 1986.)

NOTE: In order to be considered for employment an applicant must:

Complete this application (including signature)

Provide academic transcripts and/or certifications(if any required) for screening purposes. If hired, sealed official transcripts are required to be forwarded to Human Resources.

Resumes are required for Exempt positions

MILITARYSERVICE

Were you in the U.S. Armed Services? Yes No If “Yes,” list branch of service
Dates: / From / To / Rank
List duties in service including special training applicable to desired position

EDUCATION INFORMATION

Educational Institution & Address / Credit Hours / Subjects Studied / Graduated Yes or No / Diploma/Degree Received
High School /  / 
College
College
Graduate Work
Other
List academic honors, scholarships, etc., you consider significant and relevant to employment
Licenses and Certifications: List any professional licenses and certificates, such as Professional Engineer, Registered Architect, Land Surveyor, Certified Public Accountant, Registered Nurse, etc. Please list license or certificate number expiration date, and state where issued.
Computer knowledge/special skills
Other education or specialized training
List any professional and/or community organizations to which you belong. Any organization(s) which would indicate your race, creed, color, gender,religion, national origin ancestry, sexual orientation, marital status, age,disability or other protected status may be excluded.

EMPLOYMENT RECORD

Please describe your work interest or objective

List your employment history for the past 10-12 years starting with present or most recent employer. If more space is necessary, include an additional sheet.Organizations which indicaterace, creed,color, gender, religion, national origin ancestry, sexual orientation, marital status, age, disabilityor other protected status may be excluded.

Dates / Position Title/Duties / Firm or Organization
Address, Telephone Number / Name and Position
of Supervisor / Reason for leaving / Full
Time / Part Time
From
Mo/Yr / To
Mo/Yr
May we contact the employers listed? Yes No If “No,” please indicate which one(s) you do not
wish us to contact.
State your occupation during all periods not already covered by your employment history (include unemployment,
attending school, or self-employment.)
MISCELLANEOUS
List any relative (or member of your household)in our employ
Have you been convicted of a felony or misdemeanor offense more serious than a minor traffic violation?
NOTE: A conviction record is not an automatic bar to employment. Each situation is considered in relation to the position applied for.
Yes No If “Yes,” please explain
Date of Conviction
PROFESSIONAL REFERENCES

List four (4) persons who are not related to you and who have definite knowledge of your qualifications and suitability for the position for which you are applying.

Name
Occupation/Position Title / Firm or Organization
Address and Telephone Number / Number of Years Known

PLEASE READ CAREFULLY

I certify that the above statements are correct to the best of my ability. I understand that any false, misleading, intentionally or omitted information on this application(or its supporting documents)may be sufficient grounds for refusal to hire or termination without notice. I authorize Metropolitan Community College to review my education, previous employment, and other background information(where doing so is allowed by law) as may be necessary in arriving at an employment decision. I hereby release all persons who provide any such information to the College from any liability.

I hereby understand that(unless otherwise defined by applicable law) any employment relationship with this organization is of an “at will” nature, which means the Employer may discharge the Employee at any time with or without cause. I also understand(that as required by federal law) I will be required (if hired) to furnish documentation establishing my identity, and eligibility to work in the United States.

DATE
/
SIGNATURE OF APPLICANT

Applications sent electronically will require signature if interviewed

NOTICE OF NONDISCRIMINATION- Metropolitan Community College does not discriminate on the basis of race, creed, color, gender, religion, national origin ancestry, sexual orientation, marital status, age,disability, status as a disabled veteran or veteran of the Vietnam Era or other protected status. Metro highly values diversity.

Revised 3/03