RU Employment Application Form

Education:
High School
Name of High School Attended
Degree Earned
College/University
Name of College/University Attended
Degree Earned
Major
Graduate School
Name of Graduate School Attended
Degree Earned
Major
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree

Have you ever been convicted of a felony?

Yes No
If yes, please explain
Do you have a valid driver's license?

Yes No
State of issue

Current Employment:
Name of Employer
Name of Current Employer or NONE if not Employed
Position
Address of Employer

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Employer Phone

Area Code Phone Number
Salary
Name of Supervisor
Reason for Leaving? (Please be specific)
Start Date

Month Day Year
May We Contact?

Yes No
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company
Previous Employment:
Previous Employer
Name of Previous Employer
Position
Address of Employer

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Employer Phone

Area Code Phone Number
Salary
Name of Supervisor
Reason for Leaving? (Please be specific)
Start Date

Month Day Year
End Date

Month Day Year
May We Contact?

Yes No
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company
Previous Employer
Name of Previous Employer
Position
Address of Employer

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Employer Phone

Area Code Phone Number
Salary
Name of Supervisor
Reason for Leaving? (Please be specific)
Start Date

Month Day Year
End Date

Month Day Year
May We Contact?

Yes No
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked oat this company

References: (please list 2 reference other than relative and previous employers)
Reference 1
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone
Email

Applications & Skills:
Please list all applications and skills you may have that would qualify you for the desired position.

Cover Letter & Resume:
Cover Letter
Resume
Agreement:
General Information: The information set forth in my application is true and complete. In understand making false statements or omitting pertinent facts on this application will be considered sufficient cause for rejection of this application or dismissal from employment.

I understand the issuance of this application does not indicate there are any positions available and does not in any way obligate Rochester University to hire me. If hired, I am willing to abide by all present and future rules and regulations of Rochester University. I am also aware and understand the mission of Rochester University and am willing and able to uphold the ideals of the University in my daily living. I understand this application will remain active for twelve months unless I notify Rochester University otherwise.

Release of Personal Information: I hereby authorize Rochester University to collect, store, transfer and purge my personal information. I understand Rochester University may request additional information for the purpose, use and choices related to the personal information.

Release for Reference Checks: I authorize Rochester University to contact my previous employers for work-related references.

Rochester University does not discriminate on the basis of race, color, gender, age, disability or national origin in the execution of its educational programs, activities employment or admission policies except where necessitated by specific religious tenets held by the institution an its controlling body.
Voluntary Self Identification Survey:
Gender
Are you Hispanic or Latino?
Race (check all that apply)

American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Should be Empty:

Personal Information:

Employment Desired:

Education:

Current Employment:

Previous Employment:

References: (please list 2 reference other than relative and previous employers)

Applications & Skills:

Cover Letter & Resume:

Agreement:

Voluntary Self Identification Survey: