Employment Application (2-Pp.) s1

APPLICATION FOR EMPLOYMENT (SSN Voluntary, for Record Keeping and Data Processing Only) INSTRUCTIONS TO APPLICANTS TO BE CONSIDERED FOR EMPLOYMENT, YOU MUST ANSWER ALL QUESTIONS AND COMPLETE ALL SECTIONS OF THIS APPLICATION FORM. WHEN COMPLETING THIS APPLICATION, PLEASE MAKE SURE YOU

 COMPLETE THE SECTION FOR EQUAL OPPORTUNITY INFORMATION.

 APPLY FOR ONE VACANCY PER APPLICATION.

 GIVE COMPLETE INFORMATION ON YOUR EDUCATION AND WORK HISTORY (“SEE RESUME” IS NOT ACCEPTABLE).

 LIST SEPARATELY EACH JOB HELD AND YOUR DUTIES FOR EACH POSITION WHEN YOU WORKED FOR ONE EMPLOYER AND HELD MORE THAN ONE POSITION.

 CHECK FOR ACCURACY, SIGN AND DATE YOUR APPLICATION.

LIVINGSTONE COLLEGE 701 W. Monroe Street, Salisbury, NC 28144 In the business of preparing and producing leaders. Inc. 1879

APPLICANT INFORMATION Last Name First M.I. Date 4/4/18

Street Address Apartment/Unit #

City State ZIP

Phone E-mail Address

Date Available Social Security No. Desired Salary

Position Applied for

Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO

Have you ever worked for this company? YES NO If so, when?

Have you ever been convicted of a felony? YES NO If yes, explain Are you related to an employee of Livingstone College? YES NO If YES, please list their full name and relationship: EDUCATION High School Address

From To Did you graduate? YES NO Degree

College Address

Other Address

Membership in professional, honorary, or technical societies (list):

Referral Source Please indicate your referral source: If you were referred by the Employment Security Commission (Job Service) please indicate which local office:

Licenses and certifications (List, giving dates and sources of issuance): REFERENCES Please list three professional references.

Full Name Relationship

Company Phone

Address

Company Phone

Address

Company Phone

Address

PREVIOUS EMPLOYMENT

Company Phone

Address Supervisor

Job Title Starting Salary $ Ending Salary $

Responsibilities

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Company Phone

Address Supervisor

Responsibilities

May we contact your previous supervisor for a reference? YES NO

Company Phone

Address Supervisor

Responsibilities

May we contact your previous supervisor for a reference? YES NO MILITARY SERVICE

Branch From To

Rank at Discharge Type of Discharge

If other than honorable, explain: DISCLAIMER AND SIGNATURE I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature Date

CHECK THE TYPES OF WORK YOU WILL ACCEPT: 1. Permanent full-time 2. Permanent part-time 3. Temporary full-time 4. Temporary part-time

5. Any of the preceding 6. Work involving Travel 7. Shift or Split Shift Work

If you are not available for work now, enter the earliest date you could begin work (mo/day/yr.) Equal Opportunity Information The information requested below will in no way affect you as an applicant. For the purpose of filing this application, the following information is optional. The information gathered will test how well our recruitment efforts are reaching the entire population.

Date of Birth ETHNIC GROUP

(Month) (Day) (Year) 1. White (non-Hispanic) 2. Black (non-Hispanic) Gender 3. Hispanic (Mexican, Puerto Rican, Cuban, Central or South American

other Spanish origin regardless of race) Male Female 4. Asian (including Pacific Islander) 5. American Indian (including Alaskan native) LIVINGSTONE COLLEGE 701 W. Monroe Street, Salisbury, North Carolina 28144

PRE-EMPLOYMENT AUTHORIZATION FOR RELEASE OF RECORDS

I authorize any military organization, educational institution, governmental agency, bank or credit agency, former or present employer, division of motor vehicles (DMV) and any other person to entity to furnish to Livingstone College any and all available information requested pertaining to me. I understand that by signing this document Livingstone College discloses that a background check may be obtained as part of my pre- employment background investigation or after employment has begun under a contract which makes employment contingent upon completion of a background check.

I understand that the obtained record does not necessarily eliminate a candidate from employment with Livingstone College. Each background will be reviewed with respect to the nature and seriousness of any offenses in relation to the position for which a candidate has applied.

By signature on this document, I authorize Livingstone College to procure a criminal background report from a consumer or credit reporting agency and I hereby release Livingstone College from all liability or responsibility for this investigation.

I further authorize any party or agency contacted by Livingstone College or its agent to furnish criminal background information and hereby release all such parties involved from any liability and responsibility for damages for having furnished such information in good faith.

I understand that the information requested below regarding sex, race, and date of birth is for the sole purpose of gathering the above-mentioned information about me accurately, and that it will not be used to discriminate against me in violation of the law. I understand that provision of my social security number on this form is voluntary and is for the sole purpose of obtaining a criminal background report. A facsimile or photographic copy of this authorization will be as valid as the original. ------Please fill out information below ______Applicant’s Full Legal Name (Print) Social Security Number

______Maiden or Other Name Used Driver’s License Number / State

______Current Street Address Date of Birth / Race

______City, State, Zip, County Height / Weight

______Sex / Eye Color Applicant’s Signature Date ______City (ies) / County (ies) / State (s) where Applicant Has Lived during Past Ten Years