Job Application

*required information

Part One - General Information

Last name:*
First name:*
Middle name:*
Social Security Number :*
Street Address:*
City:*
*	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississppi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:*
Email:*
(A/C) Home Phone:*
(A/C) Work Phone:*
Name used on Transcripts:
Relatives now employed by the State of Tennessee:
Positions Desired *	Adjunct Faculty Cookeville Fall 2006 Adjunct Faculty ESL Adjunct Faculty Fall 2006 Adjunct Faculty Workforce and Community Development Center Adjunct Faculty, Mathematics Admissions Clerk ASL Interpreters Cookeville--Testing Tech I 84% Coordinator of Development Electrician Humphreys County-Computer Lab Tech Records Clerk 84% Secretary II, Applied Arts Modfy Testing Technician I, 84% LRC Tutor
If applying for an adjunct faculty position, please give discipline.
How did you learn of this position?
Have you ever been employed by the state of Tennessee?*	Yes No If yes, When?
Part Two - Education
Are you a high school graduate?* If no, Do you have a GED Certificate?	Yes No   Yes No
Please list all undergraduate and graduate institutions. Space has been provided for up to four degrees. Should you need more space, include such information in the comments portion at the end of the application.
College:
State:
Major:
Degree Awarded:
Year Granted:
College:
State:
Major:
Degree Awarded:
Year Granted:
College:
State:
Major:
Degree Awarded:
Year Granted:
College:
State:
Major:
Degree Awarded:
Year Granted:
Total number of graduate semester/quarter hours:
Total number of graduate semester/hours in major area:
Part Three - Experience
List experience in reverse chronological order. Space is provided for up to five most recent employers. Please furnish complete information.
Start Date:
End Date:
Employer:
Street Address:
City:
State:
Zip:
Supervisor:
Average hours worked per week:
Job Title:
Job Duties:
Start Date:
End Date:
Employer:
Street Address:
City:
State:
Zip:
Supervisor:
Average hours worked per week:
Job Title:
Job Duties:
Start Date:
End Date:
Employer:
Street Address:
City:
State:
Zip:
Supervisor:
Average hours worked per week:
Job Title:
Job Duties:
Start Date:
End Date:
Employer:
Street Address:
City:
State:
Zip:
Supervisor:
Average hours worked per week:
Job Title:
Job Duties:
Start Date:
End Date:
Employer:
Street Address:
City:
State:
Zip:
Supervisor:
Average hours worked per week:
Job Title:
Job Duties:
Part Four - Skills
Are you currently under contract with any other educational institution?	Yes No
Please list each license, certificate, or other authorization to practice a trade or profession. Teachers must specify subject area and type of certification. Space is available for three listings. If more space is needed, please use the comments area located at the end of this application.
Type of Certification:
Area of Endorsement:
License Number:
Original License Issue Date:
Current License Expiration Date:
State or Agency Issuing License:
Type of Certification:
Area of Endorsement:
License Number:
Original License Issue Date:
Current License Expiration Date:
State or Agency Issuing License:
Type of Certification:
Area of Endorsement:
License Number:
Original License Issue Date:
Current License Expiration Date:
State or Agency Issuing License:
Please list all equipment and software packages in which you are proficient:
Part Five - References & Certification
Please list three people whom you wish to serve as employment references and indicate where they may be contacted.
Name:*
Position:
Address:
City:
State:
Zip:
(A/C) Telephone:*
Name:*
Position:
Address:
City:
State:
Zip:
(A/C) Telephone:*
Name:*
Position:
Address:
City:
State:
Zip:
(A/C) Telephone:*
Have you ever been convicted of a criminal offense other than a minor traffic violation?* If yes, please provide additional information. NOTE: An affirmative answer to this question will not automatically be a bar to your employment. Factorys such as duties of the position sought, the number and nature of the offense(s), the age of the conviction(s), and the accuracy of your explanation will be taken into consideration.	Yes No
Salary: Please indicate the salary amount necessary for you to be willing to accept employment with Nashville State Tech Community College. You will not be considered for any position offering a salary less than the amount you are willing to accept. The salary you specify will not prevent you from being offered a higher salaried position. If salary is not a major consideration, please write N/A in the blank below.
What is the minimum annual salary you are willing to accept?*
Applicant's Certification: By typing your name in the box marked "Signature" below and pressing the button marked "Submit", you hereby certify that the facts in the above employment application are true and complete to the best of your knowledge. You understand that, if employed, falsified statements on this application shall be considered sufficient cause for dismissal.
Signature of Applicant:*
Date:*
Affirmative Action/Equal Employment Opportunity Data Your response to the following questions is voluntary and is requested for reporting purposes only. Refusal to provide this information will not result in adverse treatment; therefore, your cooperation is appreciated.
Name:
Social Security Number:
Date of Birth:
Gender:	Male Female
Race	White, non-Hispanic Black, non-Hispanic Hispanic Asian or Pacific Islander Native American or Alaskan Native
Date:

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