Application for Employment

POSITION TITLE		CPAG Coord
CONTACT INFORMATION
First Name:
Middle:
Last Name:
Street Address:
City:
State:		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 Mississippi 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:
E-mail Address:
Phone Number:
Date Available for Employment:
Type of Work Desired:		Type of Work Desired Full Time  Part Time  Temporary
Salary Expected:
Can you perform the essential functions of the job with or without accommodation?		Can you perform the essential functions of the job with or without accommodation? Yes  No
Do you have authorization to work in the United States?		Do you have authorization to work in the United States? Yes  No
Do you have any restrictions on your schedule?		Do you have any restrictions on your schedule? Yes  No
How did you learn of this position?		Employment Agency Indeed.com Inside HigherEd K Employee Kzoo.edu Other
If other, please specify:
EDUCATION Please indicate your most recent educational experiences.
	Type	Please select High School/GED Higher Education Trade School Other
	Name of School:
	Location:
	Major Courses / Degree Earned:
	Type	Please select High School/GED Higher Education Trade School Other
	Name of School:
	Location:
	Major Courses / Degree Earned:
	Type	Please select High School/GED Higher Education Trade School Other
	Name of School:
	Location:
	Major Courses / Degree Earned:
EMPLOYMENT HISTORY Please include military service. Indicate present or last employer first.
May we consult your present employer?		May we consult your present employer? Yes  No
	Present or Last Employer:
	Employer:
	Address:
	Employment Dates:	To
	Job Title:
	Supervisor Name:	Phone
	Essential Functions:
	Reason for Changing:
	Previous Employer:
	Employer:
	Address:
	Employment Dates:	To
	Job Title:
	Supervisor Name:	Phone
	Essential Functions:
	Reason for Changing:
	Previous Employer:
	Employer:
	Address:
	Employment Dates:	To
	Job Title:
	Supervisor Name:	Phone
	Essential Functions:
	Reason for Changing:
AREA OF INTEREST
Describe briefly type of work desired and pertinent training. Professional candidates provide information regarding thesis, academic research subjects, special work projects, languages, registration, internships etc.
REFERENCES
	Reference
	Name:
	Phone:
	Position:
	Years Known:
	Reference
	Name:
	Phone:
	Position:
	Years Known:
	Reference
	Name:
	Phone:
	Position:
	Years Known:
FILE UPLOAD - optional. Maximum filesize 10Mb
	Cover Letter
	Resume
DEMOGRAPHIC QUESTIONS - optional
Kalamazoo College is interested in learning more about you. Listed below are demographic questions that enable us to understand who is interested in our organization. Please take a moment to respond. Your participation is voluntary and we will not use your responses in any part of the candidate selection process. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability or protected veteran status.
Please indicate your gender.		Please indicate your gender Male   Female   Prefer Not to Answer
Do you consider yourself to be Hispanic/Latino?		Do you consider yourself to be Hispanic/Latino? Yes   No  Prefer Not to Answer
In addition, select one or more of the following racial categories to describe yourself:		select one or more of the following racial categories to describe yourself American Indian or Alaskan Native Asian Black or African American Native Hawaiian or other Pacific Islander White Prefer Not to Answer
APPLICANT STATEMENT
Please read the following statement before submitting. I hereby affirm that the information provided on this application (and accompanying resume, if any) Is true and complete to the best of my knowledge. I also agree that any false information, misrepresentations, or omissions may disqualify me from further consideration for employment and may result In discipline or dismissal If discovered at a later date. I authorize a thorough investigation of my past employment and/or educational background, Including discipline records, and .agree to cooperate in such investigation. I release from all liability and responsibility all person and corporations requesting or supplying such information and waive any right to notice of such disclosure. If offered employment, I agree to submit to any psychological or physical testing which may be necessary to determine my ability to perform the job for which I am being considered. I further authorize any physician or entity conducting such medical examination to release the results of such examination to Kalamazoo College. I also understand that if I have a protected disability that affects my ability to do the job I seek, I may ask Kalamazoo College to attempt to make reasonable accommodation for it. I must make my request in writing to the personneI department as soon as possible after the date l know that accommodation Is needed. I understand that all employees of Kalamazoo College are employed on an indefinite basis and are subject to termination at any time with or without notice, with or without prior discipline warning, and with or without cause. Any claims brought by an employee or a former employee and relating to employment must be brought within six months of the alleged employer infraction, or be barred.
	Please check to agree with the statement above

KALAMAZOO COLLEGE IS AN EQUAL OPPORTUNITY EMPLOYER