GROSSMONT-CUYAMACA COMMUNITY COLLEGE DISTRICT



This was created by Sharon in Pers. and e-mailed to us for a save number and some fixing. GROSSMONT-CUYAMACA COMMUNITY COLLEGE DISTRICT

Employment Services

8800 Grossmont College Drive, El Cajon, CA 92020-1799

APPLICATION FOR PART-TIME TEACHING POSITION

Applications remain active for one year from date of completion.

SUBJECT MATTER DISCIPLINE NUMBER(S) (refer to the attached discipline list)

If applying in more than one discipline, you must provide the original and a xerox copy for each.

NAME: DATE:

LAST First Middle

Mailing

Address:

No. & Street City State Zip

Business Telephone: ( ) Home Telephone: ( )

Soc. Sec. No. - -

SITE PREFERENCE: TIME PREFERENCE:

ο CUYAMACA COLLEGE ο DAY ο WEEKENDS

ο GROSSMONT COLLEGE ο NIGHT

ο BOTH ο BOTH

List California community college teaching credentials. Please provide copies. Expiration Date

Title: Major: Minor ________________ _____________

Title: Major: Minor: _____________

Title: Major: Minor: _____________

Community College courses best qualified to teach in order of priority: (include code from discipline list)

1. 4. _____________________________

2. 5. _____________________________

3. 6.

Specific areas of specialization or area of emphasis in academic major:

1. 2. 3. ____________________

EDUCATIONAL BACKGROUND

DEGREES AWARDED

| Colleges Attended | Location | Inclusive Dates | Degrees |

| |City & State |From-To |Major and Minor |

| | | |Fields of Study |

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-2-

TEACHING EXPERIENCE

| Name of School | Location | Inclusive | Subjects Taught | Full or |

| |City and State |Dates | |Part |

| | |From-To | |Time |

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OTHER RELEVANT EXPERIENCE

(may include military service, volunteer work, and/or community service)

| Activity | Location | Inclusive | Paid or Unpaid |

| |City & State |Dates | |

| | |From-To | |

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RELEVANT COURSE WORK

| Course Title | Name of School | Inclusive | Degree Applicable? |

| | |Dates |Major or Minor Fields |

| | |From-To |of Study |

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I hereby certify that the statements above are true and complete to the best of my knowledge and belief. I understand

that any false statements on this application may be the cause for my termination in the event I am employed.

I consent to references and former employers being contacted regarding this application and understand that if I am employed I must furnish official transcripts and a fingerprint processing fee.

__________________________________________________ Signature of Applicant

Yearly renewal is necessary to keep this application active. 97-0466-002W rev. 05/03js

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