The Columbus Museum, Inc.

Application for Employment

1251 Wynnton Road
Columbus, Georgia 31906
(706) 748-2562

AN EQUAL OPPORTUNITY EMPLOYER
The Columbus Museum, Inc. does not discriminate on the basis of age, race, gender, religion, national origin, disability, or veteran's status in the educational policies under which it operates; and will honor all laws relating to discrimination.

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Last name: /
First name: /
Middle name: /
Address: /
City: /
State:
Zip code: /
Primary phone number: / ( ) -
Secondary phone number: / ( ) -
Alternate/Emergency phone number: / ( ) -
E-Mail address:
Date available for employment:
List any other name(s) under which
you may have been known in the past: /
Position applying for:

Background Information

Completing a review of your criminal history is a step in our hiring process; therefore ALL criminal history (regardless of how long ago) should be included on your application as requested. Omission or misrepresentation of any information revealed in your background check may constitute grounds for immediate termination of employment. Conviction of a crime is not an automatic bar to employment. The district will consider the nature of the offense, the date of the offense, and the relationship between the offense and the position for which you are applying.

Background Information

Have you ever been CHARGED, ARRESTED, or CONVICTED of a felony or misdemeanor, including pleading nolo contender (no contest), or are you now under investigation for any such charges (traffic violations or citations included)?
Education and Training:
High School
Name of school:
Complete address of school:
Degree, Certificate or Diploma: / DiplomaG.E.D.Did not complete
Vocational School
Name of school:
Complete address of school:
Degree, Certificate or Diploma: / Certificate/DegreeStill enrolledDid not complete
Major, or Field of Study:
Dates attended:
GPA:
College/University 1
Name of school:
Complete address of school:
Degree, Certificate or Diploma:
Major, or Field of Study:
Dates attended:
GPA:
College/University 2
Name of school:
Complete address of school:
Degree, Certificate or Diploma:
Major, or Field of Study:
Dates attended:
GPA:
College/University 3
Name of school:
Complete address of school:
Degree, Certificate or Diploma:
Major, or Field of Study:
Dates attended:
GPA:
Work Experience (List all previous employers, beginning with the most recent):
For students, please use your student teaching, internships, labs and practicum as work experience.
For applicants with limited employment experience, please list relevant volunteer experiences.
May we contact your present employer? YesNo
If no, please explain:
Employer 1 (Most recent)
Dates (From/To):
Name and Address of employer:
Phone number of employer: / ( ) -
Job title/Nature of work:
Duties:
Supervisor's name and title:
Reason for leaving:
Employer 2
Dates (From/To):
Name and Address of employer:
Phone number of employer: / ( ) -
Job title/Nature of work:
Duties:
Supervisor's name and title:
Reason for leaving:
Employer 3
Dates (From/To):
Name and Address of employer:
Phone number of employer: / ( ) -
Job title/Nature of work:
Duties:
Supervisor's name and title:
Reason for leaving:
Employer 4
Dates (From/To):
Name and Address of employer:
Phone number of employer: / ( ) -
Job title/Nature of work:
Duties:
Supervisor's name and title:
Reason for leaving:
Employer 5
Dates (From/To):
Name and Address of employer:
Phone number of employer: / ( ) -
Job title/Nature of work:
Duties:
Supervisor's name and title:
Reason for leaving: /
If you are currently employed, why do you wish to change job positions?

Have you ever been discharged from any place of employment? YesNo
If yes, when, where and why?
Military Service:
Branch of Service: /
Entry/Induction date:
Separation date:
Highest rank: /
Type of discharge: /
Please note: If released from military service in the last seven years, a copy of the original DD-214 will need to be reviewed prior to hire, should an offer of employment be made.
Work-Related References:
All applicants are required to request written references to complete the application process. These references should be from present or past supervisors of work or volunteer experience. Teachers or professors from a field of study related to the position for which you are applying are also appropriate. No friends, family or personal acquaintance references will be accepted.
Reference 1
Name:
Address, including City, State and Zip Code:
Phone number: / ( ) -
Nature of relationship to applicant:
Reference 2
Name:
Address, including City, State and Zip Code:
Phone number: / ( ) -
Nature of relationship to applicant:
Reference 3
Name:
Address, including City, State and Zip Code:
Phone number: / ( ) -
Nature of relationship to applicant: /
Personal Data:
Please check the correct response. All statements must be answered before you may be considered for employment with the Columbus Museum, Inc..
1. / Are you legally eligible to work in the United States of America? / Yes / No
2. / Have you ever received an unsatisfactory evaluation on the job? / Yes / No
3. / Have you ever resigned or been discharged from any position, including the armed forces, while under the suspicion of having engaged in criminal, immoral or unprofessional conduct, or are you currently under investigation for any such charges? / Yes / No
4. / Have you ever received probation or deferred judgment of a charge? / Yes / No
5. / Have you ever been arrested or convicted for any offense involving the physical or sexual abuse of children? / Yes / No
If you answered "Yes" to any questions 2-5, please provide an explanation below.

Applicant's Certification and Agreement (Please Read Carefully):
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that falsified statements, misrepresented information, or omission of facts on this application shall be considered sufficient cause for not receiving consideration for employment, or for termination of employment if already hired. You are hereby authorized to make any investigation of my personal history as is required for the position to which I am applying for the ColumbusMuseum, Inc.. I relieve from all liability and responsibility those persons, schools, companies or corporations supplying information concerning my past work history. This application and all subsequent required documents become the property of the Columbus Museum, Inc. upon receipt by the Deputy Director.
I am in agreement with the above statements.

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