ࡱ>    e bjbjJJ ;?(_b(_b Z Z 8"2 1111111$Y47|1$" $"$"1}S2.%.%.%$"R1.%$"1.%.%&&Թv"d&t1i202&7"7&7& 0!".%'!C! 11#B 2$"$"$"$"7 Z B :  Alabama Community College SystemApplication No. APPLICATION FOR EMPLOYMENT GADSDEN STATE COMMUNITY COLLEGEPosition Information Title of position for which you are applying:Date of ApplicationPersonal InformationLast NameFirst NameMiddle Initial AddressCityStateZip Contact InformationPhone: HomeWorkCellE-mail Address Secondary and Postsecondary EducationSchool/CollegeDates Attended From / ToMajorMinorDegree(s) EarnedHigh School/ GED College  College  College  Other (Specify) Additional infromationAre you currently employed or have been employed within the last twelve months at an Alabama Community College System college? r Yes r No If yes, list the name of the college(s) and dates: ____________________________________________________ Employment HistoryPlease list most recent employment experience first.EmployerTelephone NumberJob Duties AddressDates of Employment Titler Full-timer Part-timeHr. Rate/Salary (optional) Reason for Leaving  Employment History (Continued)EmployerTelephone NumberJob Duties AddressDates of Employment Titler Full-timer Part-timeHr. Rate/Salary (optional) Reason for Leaving Employment History (Continued)EmployerTelephone NumberJob Duties AddressDates of Employment Titler Full-timer Part-timeHr. Rate/Salary (optional) Reason for Leaving Employment History (Continued)EmployerTelephone NumberJob Duties AddressDates of Employment Titler Full-timer Part-timeHr. Rate/Salary (optional) Reason for Leaving Employment History (Continued)EmployerTelephone NumberJob Duties AddressDates of Employment Titler Full-timer Part-timeHr. Rate/Salary (optional) Reason for Leaving  May we contact your current employer? r Yes r No Skills, Awards, Certificates or Professional Activities  Note: Please provide details of each. May use a separate sheet if necessary. ReferencesPlease list three references, other than relatives, who can provide information verifying qualifications, character, or work experience.Name and TitleAddressPhone Number    Family RelationshipFor the purposes of disclosure, relative includes any person related within the fourth degree of affinity or consanguinity to any job, position, or office of profit with state or with any of its agencies. Are you a relative of any employee in the Alabama Community College system, including (name of college), or any member of the Alabama Community College System Board of Trustees? r Yes r No If yes, list the name(s), relationship, and employer/position of relative(s):   Felony Conviction(s)Have you ever been convicted of or pled no contest or guilty to any felony or any crime involving theft, dishonesty, violence, or sexual misconduct? r Yes r No If yes, explain below: Consent AgreementI represent and warrant that the information I have given on this application is full and true to the best of my knowledge and belief. I further acknowledge that I understand that I must provide documented verification of education, experience, and required certifications and/or licensures. And further, I represent and warrant that I have answered fully and truthfully all questions regarding criminal convictions/records. 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I agree to hold such persons harmless, and I do hereby release them from any and all liability for damage of any nature whatsoever for furnishing such information. I understand that failure to provide full and true information on this application may result in disqualification or dismissal.Signature of ApplicantDate Visit the ACCS website at  HYPERLINK "http://www.accs.edu" www.accs.edu and click  Job Postings to sign up for email alerts. Gadsden State Community College Attention: Human Resources P.O. Box 227 Gadsden, AL 35902-0227 Phone: (256) 549-8235 Fax: (256) 439-6812 It is the policy of the Alabama Community College System, including all postsecondary community and technical colleges under the control of the Alabama Community College System Board of Trustees, that no employee or applicant for employment or promotion, on the basis of any impermissible criterion or characteristic including, without limitation, race, color, national origin, religion, marital status, disability, sex, age, or any other protected class as defined by federal and state law, shall be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program, activity, or employment. (Each institution will make reasonable accommodations for qualified disabled applicants or employees.) The following information is gathered solely for reporting purposes and will not be used to evaluate the applicant s qualifications, suitability, or desirability for employment. 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