VINCENNES UNIVERSITY APPLICATION FOR EMPLOYMENT

The filing of this application and the acceptance thereof does not indicate that there are

positions open, and it in no way obligates the University.

Date:

Phone:PARTONE: PERSONALINFORMATION

Name:Last First Middle

Address:Street City State Zip

How did you learn of this opening?

Position(s) applied for:

1.

2.

Rate of pay expected:

Rate of pay expected:

I am seeking full-time, part-time, or temporary employment

Specify hours and days if part-time:

Would you be available for weekend work if needed? Yes No

Skills you possess (check boxes for all that apply; enter details as appropriate):

Word Processing

Calculator ICash Register

Accounting Mainframe Computer

Dicta phone/T ranscriptCustodial

Sho rtha n d/Speedwriti ngAppx Rate in WPM

Typing/KeyboardAppx Ratein WPM Appx Rate in WPM

Computer Software (Enter all software-based programs that apply).

Technical Skills (ex. Artist, AV Technician, Lab Asst., Program Director - TV, specify):

Skilled Crafts (ex. Carpentry, plumber, specify):

Other (specify):

Have you ever worked for VU before?Department:

Yes No

Dates of Employment:

Can you provide proof of employment eligibility? Yes No

If you are under 18 years of age, please enter birth date:Month Day Year

PARTTWO: EDUCATIONALBACKGROUND

Name City/State Graduated Degree

High School

Co/lege!Univ.

Co/lege!Univ.

CtJ/lege!Univ.

Other

Are you presently a VU Student? Yes No How many hours per semester?

PARTTHREE: WORK EXPERIENCE(Please list last employer first or attach resume)

Employed From-To Job Title Salary Name of Supervisor Name and Address of Company Reason for Leaving

1.

2.

3.

4.

Did you work for any of the above employers under a different name? Yes No

May we contact the above employers?

Have you ever been convicted of a crime?

Yes No (indicate):

No (indicate): -Yes

List any additional training or experience which you believe may have a bearing on your qualifications for employ-ment:

List any license or certifications currently valid such as Certified Public Account, Certified Food Service Sanitarian,General Class FCClicense, etc.

Listany work related professional, trade, business, or civic activities in which you are an active member. Indicateoffices held. You may exclude membership which would reveal sex, race, religion, national origin, age, ancestry,disability, or other protected status.

I

Military ServiceEntered-Discharged Branch Rank Duties/Job

1.

2.

3.

Listany languages, other than English,you can speak, read, and/or write:Language Read Write Speak Levelof Proficiency(select)

Fluent Good Fair

1.

2.

3.

PARTFOUR: PERSONALREFERENCES

Name Address Occupation PhoneNumber

1.

2.

3.

PLEASEREADCAREFULLY

I certify that the information given in this application for employment is complete, true, and correct to the best ofmy knowledge. I understand that if employed, falsified statements on this application sholl be considered sufficientcause for dismissal. Vincennes University is hereby authorized to make any necessary and relevant investigations ofmy personal history through any appropriate investigative bureaus of your choice. The information provided is theproperty of Vincennes University and will be held confidential.

By typing your name in the area below, you are complying to the Digital Signature Standards (DSS), and acknowl-edge that you may be asked for an original signature at any time

Signature of Applicant: Date:

Vincennes University's policy is ta be in full compliance with all Federal and State Non-Discrimination and EqualOpportunity Lows, Orders, and Regulations relating to race, creed, color, national origin, religion, age, sex, handi-cap, or status as disabled veteran or veteran of the Vietnam Era.

INTERVIEWER'S COMMENTS:

II

Date: Signature of Interviewer: