Application for Employment (Non-Exempt)

Application for Employment (Non-Exempt)
Professional Name & Name on Social Security Card

First NameMiddle NameLast Name
Social Security Number (last 4 digits only)
Note: if hired, you will be required to produce a current Social Security Card and any other documents required by law.
Present Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Daytime Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Evening Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Availability For Work
Are you legally entitled to work in the United States?
Will you now or in the future require sponsorship for an employment visa status (e.g., H-1B visa status)?
Are you at least 18 years old?
Type of employment preferred:
Job I am applying for: Type here at Alva Enid Woodward
Have you worked for Northwestern before?
If yes, when?
In what capacity?
List any relatives working for Northwestern:
Educational Background
Do you have either a High School Diploma or GED?
College Name:   Name
Address:   Street Address   Address Line 2   City   State   Zip
No. Years Completed:   Years
Did you graduate?   *      Yes   No
Trade, Business or Other School Name:   Name
Address:   Street Address   Address Line 2   City   State   Zip
No. Years Completed:   Years
Did you graduate?   *      Yes   No
Prior Work History

(List in Order, Last or Present Employer First)
May Northwestern contact your present employer without notifying you first?
Employer Name:   Name
Address:   Street Address   Address Line 2   City   State   Zip
Phone:   Area Code   Phone Number
Supervisor Name:   First Name   Last Name
Your position/Job Duties:   Duties
Reasons for Leaving:   Reasons
Hire Date:   Date   End Date:   Date
Start Wage:   Start Wage      End Wage:End Wage
Employer Name:   Name
Address:   Street Address   Address Line 2   City   State   Zip
Phone:   Area Code   Phone Number
Supervisor Name:   First Name   Last Name
Your position/Job Duties:   Duties
Reasons for Leaving:   Reasons
Hire Date:   Date   End Date:   Date
Start Wage:   Start Wage      End Wage:End Wage
Employer Name:   Name
Address:   Street Address   Address Line 2   City   State   Zip
Phone:   Area Code   Phone Number
Supervisor Name:   First Name   Last Name
Your position/Job Duties:   Duties
Reasons for Leaving:   Reasons
Hire Date:   Date   End Date:   Date
Start Wage:   Start Wage      End Wage:End Wage
Additional Experience:
List any additional experience, skills, or qualifications relevant to your area of employment interest: (If you have had military experience, please list any job skills which could help you qualify for a job with us.)
References:
Please list the names, addresses, and phone numbers of 3 references, excluding relatives and former employers.
Applicant's Statement
All persons, schools, universities, firms and entities listed in this application are hereby authorized to release any information or records concerning my education, academic achievement, attendance, work performance, and personal history for the official use of Northwestern Oklahoma State University. I hereby release said persons, schools, universities, and firms from any liability for damage of whatever kind, as a result of the furnishing or receiving of such records and information.

I certify to the best of my knowledge the facts set forth in this application are accurate and complete. I understand that any falsification of information on this form will result in non-employment or, after employment, termination. Please sign the application form below.
Signature
Date Signed

MonthDayYear
Request for Supplemental Information

Note: Completion of the following information is totally voluntary on your part.
To assist us with the preparation of various governmental reports and statistical information for the Office of Civil Rights, U.S. Department of Health, Education, and Welfare, the Equal Employment Opportunity Commission, and our own Affirmative Action Plan, the following information is requested. This information will not be used to discriminate against or to show preference for any application in the hiring decision.
Name

First NameLast Name
Sex
Position Applied For
Ethnic Information
Veteran Information
Do you qualify as a Vietnam Era Veteran? Any veteran of the armed services who served on active duty for at least 181 days, any part of which occurred between August 5, 1964, and May 7, 1975, and was discharged honorably or released sooner because of a service-related disability.
Are you considered a disabled veteran by the U.S. Veterans Administration? Any person entitled to compensation by the Veterans Administration for a disability rated at 30 percent or more, or who was discharged or released from active duty by reason of service-connected disability.
Disability Information
(Any person entitled to compensation by the Veterans Administration for a disability rated at 30 percent or more, or who was discharged or released from active duty by reason of service-connected disability.)
Do you wish to declare yourself as qualifying for reasonable accommodations as provided for by the Americans with Disabilities Act?
How did you learn of this position opening?
Please verify that you are human
AFFIRMATIVE ACTION COMPLIANCE STATEMENT This institution, in compliance with Title VI and Title VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, sections 503 and 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act Amendments Act of 2008, and other applicable federal laws and regulations, and to the extent required by law, does not discriminate on the basis of race, color, national origin, sex, age, religion, genetic information, physical or mental disability, or status as a veteran in any of its policies, practices, or procedures. This includes, but is not limited to, admissions, employment, financial aid, and educational services. Inquiries concerning the application of these programs should be made to Calleb Mosburg, Dean of Student Affairs and Enrollment Management, Northwestern Oklahoma State University, 709 Oklahoma Boulevard, Alva, OK 73717, (580) 327-8415.
Should be Empty:

Application for Employment (Non-Exempt)

Availability For Work

Educational Background

Prior Work History

Applicant's Statement

Request for Supplemental Information

Veteran Information

Disability Information