APPLICATION FOR EMPLOYMENT



APPLICATION FOR EMPLOYMENT

WESTERN OKLAHOMA STATE COLLEGE

2801 North Main

Altus, Oklahoma 73521

Name (Last First Middle) Social Security Number

Address:

Street City State Zip

( ) ( )

Telephone Number Business Phone Citizenship

Position (Subject) Desired Email Address

EDUCATIONAL DATA

Graduated? Yes No

High School Attended

Address of High School City State Zip Code Year Graduated

Bachelor Yes No

College or University Attended Completed?

Address of University City State Zip Code

Total Undergraduate Hours Degree Date Completed

Major Hours in Major Minor Hours in Minor

Master

Degree Yes No

College or University Attended Completed

Address of University City State Zip Code

Total Hours at Master Level Degree Date Completed

Major Hours in Major Minor Hours in Minor

Thesis Title

Doctoral

Degree Yes No

College or University Attended Completed

Address of University City State Zip Code

Total Hours at Doctoral Level Degree Date Completed

Major Hours in Major Minor Hours in Minor

Dissertation Title

Have you attended a Community/Junior College or completed a course(s) in Community/Junior College Education? If so, please identify the institution and elaborate.

Graduated? Yes No

College Attended

Address of College City State Zip Code

Total Hours Degree Date Completed

PROFESSIONAL WORK EXPERIENCE

(Start with present position)

1.

Employer’s Name Address City State Zip Code

( ) From: to:

Telephone Number Position Title Dates of Employment

Duties of Position:

2.

Employer’s Name Address City State Zip Code

( ) From: to:

Telephone Number Position Title Dates of Employment

Duties of Position:

3.

Employer’s Name Address City State Zip Code

( ) From: to:

Telephone Number Position Title Dates of Employment

Duties of Position:

ADDITIONAL WORK EXPERIENCE

Employer’s Name Address City State Zip Code

( ) From: to:

Telephone Number Position Title Dates of Employment

Duties of Position:

List special job-related skills, honors and interests:

Honors and/or awards:

Professional Affiliations:

Publications:

Institutes and Special Training Courses:

REFERENCES

(At least two of the three references should be professional)

Name Address City State Zip Code

( )

Telephone Number Position Work Relationship

Name Address City State Zip Code

( )

Telephone Number Position Work Relationship

Name Address City State Zip Code

( )

Telephone Number Position Work Relationship

Please add any information you desire which supplies greater detail or would be helpful in our evaluation of your qualifications and credentials.

NOTE: Official transcripts of all college and university work should accompany this application.

|To the best of my knowledge, the information herein is true and complete. I |This Institution in compliance this Title VI of the Civil Rights Act of 1964, |

|authorize Western Oklahoma State College to verify any or all information given |Executive Order 11246 as amended, Title IX of the Education Amendments of 1972 |

|and understand that falsification of this application will be grounds for |and other federal laws and regulations, does not discriminate on the basis of |

|dismissal if employed. I authorize previous employers, references or any other |race, color, national origin, sex, age, religion, handicap or status as a veteran|

|person to whom the College may refer, to provide information concerning me |in any of its policies, practices or procedures, this includes but is not limited|

|personally or my previous employment. |to admissions, employment, financial aid and educational services. |

| | |

|Employment at WOSC is “at will” and therefore is not guaranteed and may be | |

|terminated at any time by the employee or the employer without notice, reason or | |

|cause. | |

Signature of Applicant Date

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