Enrollment Manager - Coahoma Community College

3240 Friars Point Road, Clarksdale, MS 38614

www.coahomacc.edu

JOB APPLICATION

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

Position Applying For:*

Full Name*

First NameMiddle NameLast Name

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email Address*

Date of Application:*

MonthDayYear

Phone Number*

Area CodePhone Number

Date Available:*

MonthDayYear

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Answer:

YESNO

Have you ever filed an application with us before? If Yes, give date below.

Answer:

YESNO

Date of Previous Application

MonthDayYear

Have you ever been employed with us before? If Yes, give date below.

Answer:

YESNO

Date of Previous Employment

MonthDayYear

Do any of your friends or relatives, other than spouse, work here?

Answer:

YESNO

If Yes, name, relationship and location

Are you currently employed?*

YESNO

May we contact your present employer?*

YESNO

Are you prevented from lawfully becoming employed in ths country because of Visa or immigration Status? Proof of citizenship or immigration staus will be required upon employment.

Answer:

YESNO

What is your desired salary range?*

Are you available to work?*

FULL-TIMEPART-TIMETEMPORARY

Are you currently on “lay‐off” status and subject to recall?*

YESNO

Can you travel if a job requires it?*

YESNO

Please indicate shift.*

Shift 1Shift 2Shift 3

EDUCATION:

High School, Address, Number of Years Completed and Degree/Diploma*

Undergraduate College, Address, Number of Years Completed and Degree/Diploma*

Graduate/Professional College, Address, Number of Years Completed and Degree/Diploma*

Upload Unofficial Transcript

Upload a File

Other (Specify), Address, Number of Years Completed and Degree/Diploma*

ADDITIONAL JOB RELATED SKILLS:

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.

Answer:

YESNO

WORK EXPERIENCE:

Employer, Address, Phone, Your Job Title, Supervisor Name, & Reason for Leaving

Briefly describe duties for the position above.*

Employer, Address, Phone, Your Job Title, Supervisor Name, & Reason for Leaving

Briefly describe duties for the position above.*

Employer, Address, Phone, Your Job Title, Supervisor Name, & Reason for Leaving

Briefly describe duties for the position above.*

Upload Resume

Upload a File

PERSONAL REFERENCES:

Name, Occupation, Phone, & Best Time to Call

Criminal Background Investigation is required prior to offer of employment: In accordance with policy; finalist for this position will be subject to criminal background investigations. The applicant is responsible for fees.

Coahoma Community College is an active participant in the Employment Eligibility Verification Program (E-Verify). E-Verify electronically confirms an employee's eligibility to work in the United States as required by the Department of Homeland Security.

Coahoma Community College is an equal opportunity institution in accordance with civil rights and does not discriminate on the basis of race, color, national origin, sex, disability, age, or other factors prohibited by law in any of its educational programs, activities and employment opportunities. The following person has been designated to handle inquiries regarding the non-discrimination policies: Michael Houston, Director of Human Resources/Coordinator for 504/ADA, Title IX Compliance Officer, Office #A100, Vivian M. Presley Administration Building, 3240 Friars Point Road, Clarksdale, Mississippi 38614, Phone: (662)621-4853, Email: mhouston@coahomacc.edu.

APPLICANT STATEMENT:

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Employer.

Signature Below:*

Last four digits of SSN:*

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Non-Discrimination