Employment Application

Personal Data:

Name*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Are you authorized to work in the U.S. on an unrestricted basis?

Yes
No

Referral Source:

Name of Source

if applicable

Did you serve in an AmeriCorps, Peace Corps, or other national service program?

Yes
No

Name of Service Program

Are you a veteran of the U.S. military service?

Yes
No

Type of Position Desired:

Listed are the kinds of positions usually available. Please check all those in which you would accept employment:

If Other, Please Indicate:

Work Schedule Desired:

Full-Time
Part-Time
Temporary

When are you available to start work?

If you wish to work part-time, what hours can you work?

Please give dates you are available for temporary work.

Relevant Skills

Clerical Skills

Typing
Accounting
Cashier

Words Per Minute Typing

Facility Services Skills

Please list mechanical, construction, groundskeeping, and custodial skills.

Library Skills

Please list specific skills.

Computer Skills

Please list software and hardware that you are familiar with.

Other Skills

Please list any other skills that may pertain to the position you are interested in.

In addition to your work history, what other experiences or qualifications would especially fit you for work with Graceland University?

Employment

Please list all employment beginning with the most recent first. If you have a resume or curriculum vitae to upload, you can skip this section.

Company Name

Most recent employer

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone Number

Name of Supervisor

Job Title and Description of Your Work

When were you employed there?

Please state month and year

What was your weekly pay?

Include both starting and ending

What was your reason for leaving?

Add a second company?

Yes
No

Company Name

Second most recent employer

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone Number

Name of Supervisor

Job Title and Description of Your Work

When were you employed there?

Please state month and year

What was your weekly pay?

Include both starting and ending

What was your reason for leaving?

Add a third company?

Yes
No

Company Name

Third most recent employer

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone Number

Name of Supervisor

Job Title and Description of Your Work

When were you employed there?

Please state month and year

What was your weekly pay?

Include both starting and ending

What was your reason for leaving?

List employers we should not contact and the reason why.

We may contact the employers listed above unless you indicate those you do not want us to contact.

Educational Record

High School Name and Address

Year Graduated

Last Year Completed

1
2
3
4

College/University Name and Address

Year Graduated

Last Year Completed

1
2
3
4

List Diploma/Degree

College/University Name and Address

Year Graduated

Last Year Completed

1
2
3
4

List Diploma/Degree

Professional References

Reference #1 Name and Occupation

Reference #1 Phone Number

Reference #1 Email Address

Reference #2 Name and Occupation

Reference #2 Phone Number

Reference #2 Email Address

Reference #3 Name and Occupation

Reference #3 Phone Number

Reference #3 Email Address

Cover Letter, Resume and Reference Upload*

Upload either a .pdf, .doc, or .docx file. Maximum file size: 5MB.

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 5 MB.

Consent Authorization*

I authorize Graceland University to make an investigation of any or all of the facts set forth in this application.

I certify that all statements made by me on this application are true and complete to the best of my knowledge. I understand that the omission of pertinent and material facts or falsification of any information in this application is grounds for refusal to hire or, if I have been hired, grounds for termination.

I authorize my previous employers, schools, or persons named as references to give any information regarding an employment or educational record. I agree that Graceland University and my previous employers will not be held liable in any respect if a job offer is not extended, withdrawn or my employment terminated because of reference information, false statements, omissions or answers made by me on this application. If I am employed by Graceland, I will comply with all policy and procedures as set forth in any communication to employees.

In compliance with Immigration Reform and Control Act of 1986, I understand that I will be required to provide approved documentation that verifies my right to work in the United States on my first day of employment.

I understand that employment at Graceland University is "at will," which means that either I or Graceland University can terminate the employment relationship at any time, with or without pior notice, and for any reason not prohibited by statue. All employment is continued on that basis. I understand that no supervisor, manager or executive of Graceland University, other than the President, has any authority to alter the foregoing.

I agree to the Consent Authorization.

Signature

First Last

Date of Application

Phone

This field is for validation purposes and should be left unchanged.