Application for Employment

Application for Employment

Path Breaker Program Assistant Coordinator
California Indian Nations College (CINC) will not discriminate against any individual based on sensory, physical or mental abilities/disabilities, medical condition, age, sex, sexual orientation, gender identity, race, national origin, ethnicity, religion, language, marital status, tribal affiliation and non-tribal affiliation, socioeconomic status, veteran status, geographic region, and ancestry. CINCollege.org/about Please carefully read and answer all questions.

You will not be considered for employment if you fail to completely answer all the questions.
Position: (Interim)Path Breaker Program Coordinator

Division: Student Affairs

Brief:

As part of the Student Affairs Team, the Path Breakers Program Coordinator will help administer CINC’s Path Breakers Program. The Path Breakers Program is a multi-year bridge initiative designed to meet students where they are and prepare them for academic success before, during, and after earning their associate degree. For many students, the next step will be transferring to a four-year institution to complete a bachelor’s degree. The Path Breakers Program provides comprehensive, holistic, and personalized support through student services, skills-building opportunities, summer bridge experiences, academic and cultural workshops, along with a unique post-graduation follow-up to ensure continued student success.
Personal Data
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date you can start work

MonthDayYear
Date
Salary Desired
Tribal Affiliation
If yes, Tribe name
Position Information

Check all that you are willing to work
Hours
Are you authorized to work in the United States on an unrestricted basis?
Have you been told the essential functions of the job or have you viewed the job description listing the essential functions of the job?
Can you perform these essential functions of the job with or without reasonable accommodation?
Qualifications

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training
School Name
Degree Received
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Name
Degree Received
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Name
Degree Received
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Special Skills
List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.)
References

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you do not have three professional references, then list personal, unrelated references.
Reference #1

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Reference #2

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Reference #3

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Work History

Start with your present or most recent employment and work back.
Job Title #1
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Company Name
Supervisor's Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties
Reason for Leaving
May we contact your present employer?
Job Title #2
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Company Name
Supervisor's Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties
Reason for leaving
Job Title #3
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Company Name
Supervisor's Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties
Reason for leaving
Job Title #4
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Company Name
Supervisor's Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties
Reason for leaving
By submitting this application, I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.

I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.
Attachments
Cover Letter

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Resume or CV

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Diversity Statement

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Should be Empty:

Personal Data

Position Information

Qualifications

References

Work History

Attachments