Carrollton, Georgia 30118-4240

Application for Employment

PERSONAL DATA

Name

Social Security Number

Present Address                                

Telephone:   Home Business

May we call you at your business?

Are you presently eligible to work in the United States?  Yes     No   (Federal Law requires proof of your authorization to work in the United States.  You will be required to provide proof of your identity and employment eligibility within three days of employment.)

Please indicate the type of position for which you are applying (include job number if applying for specific position)

Have you previously been employed at the State University of West Georgia? Yes   No  

If yes, please give the dates of employment, position, and reason for terminating employment.

 If you answer "yes" to any of the questions listed below, please explain in Comments section.

Have you ever been discharged or asked to resign from a position?    Yes     No

Have you ever pleaded no contest to or been convicted or found guilty of a felony or misdemeanor crime?     Yes      No      If yes, please provide full details below.

Are your elated by blood or marriage to any person now employed at the State University of West Georgia?  Relatives are defined as spouse, parents, children, siblings and any in-law of the foregoing.         Yes     No        If yes, please list names and relationship below.

Comments:

 EDUCATIONAL DATA

Please provide a complete education history

High School or Equivalent 

Name

Address

Years Completed

Did you graduate? Yes No

Degree or certificate

 

College or University

Name

Address

Years Completed

Did you graduate? Yes No

Degree or certificate

 

Graduate or Professional

Name

Address

Years Completed

Did you graduate? Yes No

Degree or certificate

 

Vocational/ Technical

Name

Address

Years Completed

Did you graduate? Yes No

Degree or certificate

 

Other(Please specify):

Name

Address

Years Completed

Did you graduate? Yes No

Degree or certificate

 

Please list fields of work for which you are licensed, registered or certified.  Also, please explain when and where you obtained the license, registration or certification.

Please list specific courses you have successfully completed in the area of employment for which you are applying.   Include specific computer/software training.

Please check skills and/or experience that you possess:

Note: Hold down the Ctrl key to make more than one selection

If you select typing as one of your skills please enter wpm:

Computer Skills

Note: Hold down the Ctrl key to make more than one selection

Other skills/experience (please specify below) :

 

EMPLOYMENT DATA / WORK HISTORY

BEGIN WITH YOUR PRESENT OR MOST RECENT EMPLOYMENT

Are you a veteran?    Yes     No    If yes, please include your military service in the following work history.

Employed:  From To  Total Years Months

Starting Salary per Final Salary per

Employer Emp. Phone   

Address

Type of Business   Your Position

Specific Duties:   

Reasons for Leaving:

 

Employed:  From To  Total Years Months

Starting Salary per Final Salary per

Employer Emp. Phone

Address

Type of Business   Your Position

Specific Duties:   

Reasons for Leaving:

 

Employed:  From To  Total Years Months

Starting Salary per Final Salary per

Employer Emp. Phone

Address

Type of Business   Your Position

Specific Duties   

Reasons for Leaving

 

Employed:  From To  Total Years Months

Starting Salary per Final Salary per

Employer Emp. Phone

Address

Type of Business   Your Position

Specific Duties:   

Reasons for Leaving:

 

Employed:  From To  Total Years Months

Starting Salary per Final Salary per

Employer Emp. Phone

Address

Type of Business   Your Position

Specific Duties:   

Reasons for Leaving:

 

Employed:  From To  Total Years Months

Starting Salary per Final Salary per

Employer Emp. Phone

Address

Type of Business   Your Position

Specific Duties:   

Reasons for Leaving:

 

REFERENCE DATA

List three persons who can provide a reference regarding your work experience and ability.

Name Address Phone

Name Address Phone

Name Address Phone

List person to be notified in case of emergency or accident:

Name Relationship

Address Telephone