HEC EMPLOYMENT APPLICATION

Higher Education Consortium of Metropolitan St. Louis

Today’s Date

Date

Name

Present Address

Zip Code

Home Telephone Number

Cell Phone

Social Security No. _XXX_– _XX

No

Are you 18 years or older?Yes

Date of Birth:

Are you legally authorized to work in the United States?YesNo

No Date of Birth:

Date

Proof of eligibility documentation must be provided at time of hire as required by law.

Position Applied For

Employment desired:

Full-timePart-timeTemporary

Specify days and hours available, if part-time:

Date available to start work:

Date

Date available to start work:

Have you applied for employment with this Organization within the last 12 months? ☐ YesNoYes

Salary Expectations:

Have you ever worked for us before?

YesNo

(Please provide your name of record at that time, job title and dates of employment)

Date

High School

Location of High School

Number of Years Completed

Major & Degree

College

Location of College

Number of Years Completed

Major & Degree

Technical or Vocational School

Location of Technical or Vocational School

Number of Years Completed

Major & Degree

Professional School

Location of Professional School

Number of Years Completed

Major & Degree

Higher Education Consortium of Metropolitan St.Louis

SPECIAL SKILLS/ADDITIONAL TRAINING

Please describe any special job-related skills and qualifications acquired for employment, other education or volunteer experiences, etc. Do not include experiences which would indicate race, color, creed, religion, sex, sexual orientation, national origin, marital status, Vietnam-era veteran status, special disabled veteran status, status with regard to public assistance, membership or activity in a local commission, disability or age.

Name of Employer

Address & Phone Number:

Position:

From: (mm/yyyy)

To (mm/yyyy)

Name & Title of Supervisor:

Reason for Leaving:

Brief Description of your work and responsibilities:

May we contact this employer?

YesNo

Name of Employer

Address & Phone Number:

Position:

Dates Employed: From (mm/yyyy) - To (mm/yyyy)

Name & Title of Supervisor :

Reason for Leaving:

May we contact this employer?

YESNO

Brief Description of your work and responsibilities:

Higher Education Consortium of Metropolitan St.Louis

Name of Employer

Address & Phone Number:

Position:

Dates Employed: From (mm/yyyy) - To (mm/yyyy)

Name and Title of Supervisor:

Reason for Leaving:

BRIEF DESCRIPTION OF YOUR WORK AND RESPONSIBILITIES:

MAY WE CONTACT THIS EMPLOYER:

YESNO

Name of Employer

Address & Phone Number:

Position:

Dates Employed: From (mm/yyyy) - To (mm/yyyy)

Name and Title of Supervisor:

Reason for Leaving:

May we contact this employer?

YESNO

BRIEF DESCRIPTION OF YOUR WORK AND RESPONSIBILITIES:

Please list two Professional References.

Name:

Position:

Email Address:

example@example.com

Cell Number:

Company Name:

Company Address:

Company Phone Number:

Name:

Position:

Cell Number:

Email Address:

example@example.com

Company Name:

Company Address:

Company Phone Number:

Higher Education Consortium of Metropolitan St.Louis

APPLICANT: Please read the following carefully before signing this application.

I certify the information given by me is true in all respects.
I understand that the misrepresentation or omission of facts on this application, on my resume or during any stage of the hiring process will eliminate me from further consideration or if discovered after hire may result in the termination of my employment. I understand that the information contained in this employment application or my being invited to participate in any stage of the hiring process is NOT intended to create an employment contract between this Organization and myself. If an employment relationship is established, I understand that I have the right to terminate my employment at any time, for any reason or no reason, with or without notice, and this Organization has the right to terminate my employment at any time, for any reason or no reason, with or without notice. This Organization’s policies and procedures, including employment at will, cannot be modified in any way without express written intent to do so by the Board of this organization. I understand that, in connection with the routine processing of your employment application, the Organization may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Organization will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.
Unless otherwise noted above, I authorize this Organizationand its representatives to contact my prior employers, former supervisors and Company personnel, schools and all others for the purpose of verifying the information I have supplied during the selection process and for obtaining job-related information regarding my knowledge, skills, abilities, performance of duties and compliance with policies. I authorize my prior employers to provide this Organization any job-related information, personal or otherwise, they may have regarding me and I release this Organization and them from any liability resulting from the release of this information. I further authorize all employers, schools and other persons to provide any information or transcripts that may be requested by this Organization which will be used to determine if I am qualified to perform the job duties for which I am applying. I understand that all Organization property must be returned and any indebtedness to the Organization must be paid on or before my last day of work. I authorize the Organization to deduct from my final paycheck an amount necessary to satisfy any unpaid obligation.

By signing below, I acknowledge that I have read, understand and agree with the above statements.

Higher Education Consortium of Metropolitan St. Louis provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, veteran status or genetics. In addition to federal law requirements, Higher Education of Consortium of Metropolitan St. Louis complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

HEC EMPLOYMENT APPLICATION

Please Print

GENERAL INFORMATION

EMPLOYMENT DESIRED

EDUCATION

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION

NUMBER OF YEARS COMPLETED

MAJOR & DEGREE

EMPLOYMENT HISTORY

(Please Start With Your Present or Most Recent Position)

EMPLOYMENT HISTORY

SIGNATURE

Signature of Applicant Date