Staff Application

Position Details

Position(s) Applied For: *

Date of Application

Date

Referral Source:

Date of Availability

Date

Personal Information

Name *

First Name Middle Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone Number *

- Area Code Phone Number

Email *

example@example.com

Have you ever submitted an application with Mount St. Mary's University before?

If yes, please give dates:

Are you legally authorized to work in the U.S.?

Do you have a current driver's license?

Can you travel if job requires it?

Have you ever been convicted of a crime other than a minor traffic offense?

If yes, please provide details (date and location for all convictions):

Educational Background

High School Name: *

Location of High School: *

Years Completed: *

Year Graduated: *

Major/Degree:

College/University Name 1:

Location of School:

Years Completed:

Year Graduated:

Major/Degree:

College/University Name2:

Location of School:

Years Completed:

Year Graduated:

Major/Degree:

Trade or Business School:

Location of School:

Years Completed:

Year Graduated:

Major/Degree:

Employment History

Start with your present or last job. Include any job-related military assignments and volunteer activities. If you need additional space, please continue on a separate page.

Employer 1:

Telephone:

Dates Employer: (to/from)

Address:

Job Title:

Starting rate: (per hour)

Ending rate: (per hour)

Summarize the type of work performed and job responsibilities:

Immediate supervisor name and title:

Telephone:

Reason for Leaving:

May we contact for reference?

Employer 2:

Telephone:

Dates Employer: (to/from)

Address:

Job Title:

Starting rate: (per hour)

Ending rate: (per hour)

Summarize the type of work performed and job responsibilities:

Immediate supervisor name and title:

Telephone:

Reason for Leaving:

May we contact for reference?

Employer 3:

Telephone:

Dates Employer: (to/from)

Address:

Job Title:

Starting rate: (per hour)

Ending rate: (per hour)

Summarize the type of work performed and job responsibilities:

Immediate supervisor name and title:

Telephone:

Reason for Leaving:

May we contact for reference?

Skills and Qualifications

Skills and qualifications relevant to the position you are applying for.

What office equipment can you operate?

Are you computer literate?

Describe your computer experience:

If job related, what languages do you speak fluently:

Languages you can read:

Languages you can write:

Summarize any other special skills, training and/or characteristics of yourself that may qualify you as being able to perform job-related functions in the position for which you are applying: *

Please provide a brief summary of your experience and its correlation to the position for which you are applying: *

References

List name and telephone number of three (3) business/work references who are not related to you and are not previous supervisors. If not applicable, list three (3) school or personal references not related to you.

Reference Name 1: *

Telephone: *

Years Known: *

Reference Name 3: *

Telephone: *

Years Known: *

Reference Name 3: *

Telephone: *

Years Known: *

Release of Information

I hereby authorize my former employers and individuals listed herein to release to Mount St. Mary's University, and any agent acting on its behalf, my records from any and all former employers, references, and any or all educational institutions, as well as information as to my character and ability and verification of matters stated herein. I hereby certify that the information supplied in this application and other submitted application materials are complete and correct. I understand that any omission or misstatement herein can be grounds either for refusing to hire me or for terminating my employment if I have already been hired. Moreover, I hereby release Mount St. Mary's University, and any agent acting on its behalf from any and all liability of whatever nature by reason of requesting such information from any person.

At Will Employment

I hereby acknowledge that I have read and understand the foregoing. I certify that the information contained in this application and/or resume is true, complete, accurate, and that I have withheld nothing that would, if disclosed, affect my application/employment in an unfavorable fashion.I further agree that my employment and compensation can be terminated at will, at any time, with or without cause, either at my option or that of Mount St. Mary's University. It is further understood that this at will employment relationship may not be changed by any written document or by conduct, unless an authorized executive of the organization specifically acknowledges such change in writing. No employee or representative of Mount St. Mary's University, other than the President, Executive Vice President or Director of Human Resources, has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing provisions as stated above.

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Position Details

Personal Information

Educational Background

Employment History

Skills and Qualifications

References

Release of Information

At Will Employment