Please Print Or Type s1

The University of San Diego is an Equal Opportunity Employer University of San Diego 5998 Alcalá Park, Maher Hall 101 San Diego, CA 92110-2492 Office 619-260-4594 Job line 619-260-4626 www.sandiego.edu

Application Procedures We welcome your interest in employment with the University of San Diego. Current vacancies are updated every Monday on our web site and our 24-hour Job Line. A cover letter and résumé may be attached to applications, but will not be accepted in lieu of an application. Applications for posted positions must be received in Human Resources by 5:00 p.m. on the designated closing date. Separate application materials are required for each position of interest. Photocopies of application will be accepted. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, marital status, national origin, gender, physical or mental disability, veteran status or age.

Please Print or Type Today’s Date Job Title Job Number

Last Name First Name M.I. Other Names Used

Address City State Zip Code

E-mail Home Telephone Business/Message Telephone Do you have a valid driver’s license? Yes No State: Salary Requirements Will you work Preferred Hours Have you been employed by USD? No Full Time Continuing Yes (department and position) Part Time Temporary

Do you have any relatives employed by USD? Yes Referred by (Give name and department) No

Have you ever been convicted or plead guilty to felony? A conviction is not necessarily disqualifying. Each case will be evaluated on its own merits and its applicability to the position. Yes (List circumstances, places and dates of conviction) No

Do you require any special accommodations for: (a) The interview? (b) To perform the duties of the job as you presently understand them? Yes (Explain) No Yes (Explain) No

Education Circle highest grade completed: 8 9 10 11 12 College: 1 2 3 4 Graduate School: 1 2 3 4 Name of School Location Degree/Diploma Major Minor High School (GED)

College/University

Graduate School

Are you attending school now? List courses/ training programs you have completed that relate to this job:

List equipment you are capable of operating: Certificates and licenses:

List software for which you have a working knowledge:

What special qualifications, skills, experience (special projects), interests would you bring to this position?

REFERENCES Name/Title: Name/Title:

Organization: Organization:

Telephone Number: Telephone Number: The University of San Diego is an Equal Opportunity Employer University of San Diego 5998 Alcalá Park, Maher Hall 101 San Diego, CA 92110-2492 Office 619-260-4594 Job line 619-260-4626 www.sandiego.edu

Relationship: Relationship: EMPLOYMENT RECORD - COMPLETE IN FULL List present or most recent experience FIRST- Include U.S. Armed Services and volunteer work. If attaching a résumé, you need not duplicate the “Duties/Details” section(s).

Dates (Mo/Yr) Total Yrs/Mo Organization name and address Position Title From To

Salary No. of hrs/week Your Immediate Supervisor

Reason for leaving: Telephone Number

Duties/Details:

Are you presently employed? May we contact your employer? May we contact your former employer(s)?

All individuals who are offered a position at the University of San Diego must present documents proving both identity and legal right to work in the United States.

I hereby certify that all statements on this application are true and complete to the best of my knowledge and belief. If employed, I understand that any falsification of this record or failure to disclose fully the information requested may be considered cause for termination.

Signature Date

Job Number______

APPLICANT SURVEY FORM The University of San Diego is an Equal Opportunity Employer. The following information is for statistical purposes only and is not used to make employment decisions.

Please check appropriate boxes.

Female Male Disabled

How did you find out about the job?

Walk in/posting USD web site USD Job line

CA Employment Union Tribune HERC web site Development Department

Employment agency Employee referral Advertisement (Name) (Name)

Other web site Other: (Name) (Name)

RACE OR ETHNIC GROUP(s) (Please check all that apply)

African-American/Black Hispanic/Latino: persons having origins in Mexico, Puerto (not of Hispanic origins): persons having origins Rico, Cuba, Central or South America, or other Spanish culture in any of the black racial groups. or origin regardless of race. This does not include persons of Portuguese culture or origin.

American Indian or Alaskan Native: persons Native Hawaiian or Other Pacific Islander: persons having having origins in any of the original peoples of origins in any of the original peoples of Hawaii, Guam, Samoa or North America and who maintain cultural identification other Pacific islands. through tribal affiliation or community recognition.

Asian: persons having origins in any of the original White: persons having origins in any of the original peoples peoples of the far East, Southeast Asia or the Indian of Europe, North Africa or the Middle East. sub-continent (e.g. Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippines, Thailand and Vietnam).