Application for Employment

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1 Application for Employment The Armand Hammer United World College of the American West (UWC-USA) is an Equal Opportunity Employer. UWC-USA offers equal employment opportunity to all applicants for employment and all employees regardless of race, age, religion, color, national origin, ancestry, sex, physical or mental handicap or serious medical condition, genetic information, veteran status, military service, spousal affiliation, sexual orientation, gender identity, or any other status protected by applicable law. An applicant who does not meet the minimum qualifications of the position(s) for which the applicant applies will not be considered for employment. Today's Date: Last Name: First Name: Middle Initial: Street Address: City, State and Zip Code: Home Telephone Number: Mobile Telephone Number: Address: Person to contact in an emergency: Name: Position Desired: Salary Desired: Date you can start: What hours and days are you available to work? Mon. Tues. Wed. Thurs. Fri. Sat. Sun. What is the total number of hours you are available to work per week? Are you on layoff or subject to recall? Are you able to work overtime, if asked? How did you become aware of the position(s) for which you are applying? Internet Advertisement College/Recruiting Other: Print Advertisement Friend Employment/Search Agency Employee (indicate name: ) Name(s) of relative(s), if any, currently employed by UWC-USA: Have you ever applied to UWC-USA before? If yes, list date(s): Have you ever been employed by UWC-USA before? If yes, list position, dates of employment and reason for leaving: Are you legally authorized to work in the United States? If yes, will you be able to submit proof of the above? Are you now or will you at anytime be seeking visa sponsorship? Are you under eighteen years of age? Are you presently employed? Have you ever been discharged from a position? If yes, please provide details (date and reason(s) for discharge):

2 Employment History Start with your present or most recent employer and work back. Give employer s complete address, including street, city, state, and zip code. Account for employment for the past 10 years. Please account for any time period(s) between positions when you were not working. You may include any verifiable work performed on a volunteer basis. Use additional sheets if necessary. UWC-USA may contact any of these persons or entitites to obtain an employment reference. Please include any other information that you consider relevant to your ability to perform the position for which you are applying. Military Experience Have you ever had U.S. military experience? If yes, branch? Rank at Discharge Duties Performed? Rev d 8/10 2

3 Education and Training High School Name of School: Address of School: Number of Years Completed: Type of Diploma: College Graduate School Other Special Skills and Qualifications Summarize any special job-related skills and qualifications, including professional licenses and/or certifications (please indicate the applicable organization, state issued, date issued and number). Honors and Activities List any academic or professional honors or activities you have received or participated in during your education or professional career. Restrictive Covenants and Conflicts of Interest Have you signed any agreements with your current or former employers that impose any restrictions on your work for others (this includes, but is not limited to, agreements regarding confidentiality, non-disclosure, non-solicitation, or non-compete agreements)? If yes, you may be asked to provide UWC-USA with relevant sections(s) of any agreement(s). Are you currently engaged in any business activity including, but not limited to, acting as an employee (including self-employment, director or officer), consultant, agent or in any other capacity with any business that may potentially be in conflict with your duties at UWC-USA, if you are hired? (Note: If you are employed by UWC-USA, you may not engage in any outside business activities without the express written approval of the President.) If yes, please describe the nature of the business activity. Rev d 8/10 3

4 Professional References May we contact your present employer? PLEASE DO NOT RESPOND TO THE FOLLOWING QUESTION UNTIL AFTER YOU HAVE READ AND/OR DISCUSSED THE JOB DESCRIPTION OF THE POSITION(S) FOR WHICH YOU ARE APPLYING. Do you believe that you would be able to perform the essential functions of the position(s) for which you are applying, with or without a reasonable accommodation? Criminal Record Have you ever been convicted of a criminal offense? If yes, please explain A criminal conviction will not necessarily disqualify you from employment. Factors such as the nature and gravity of the offense, the time that has passed since the conviction and/or completion of the sentence, and the nature of the job for which you are being considered, will be taken into account. Rev d 8/10 4

5 Certification I certify and affirm that the information provided in conjunction with the application process, including the information provided on this Application for Employment and any resume submitted, is true, accurate, complete and fairly represents my qualifications and disqualifications. I certify that I am not engaged in any outside business activities other than those listed above. I acknowledge that as part of my normal job duties at UWC-USA, I may be required to work overtime, travel and perform other duties as specified by UWC-USA. I hereby authorize UWC-USA to investigate all information pertinent to my Application for Employment in order to determine my qualifications for employment which will include contacting former and/or current employers or any person or entity listed on this Application for Employment. I hereby authorize all persons and entities having information relevant to my application to provide that information to UWC-USA and I hereby agree to hold harmless UWC-USA and all those providing information to UWC-USA from any liability arising out of or as a result of the request for, provision of, or use of such information. I understand that any offer of employment may be rescinded or my employment terminated if my references are inadequate or unacceptable to UWC-USA or if I violate any of the provisions of this Certification. I further understand that if I am hired by UWC-USA, I must abide by all rules and policies of UWC-USA which, other than the at-will employment policy, may be changed without notice at the sole discretion of UWC-USA. I understand that completion of this Application for Employment does not assure me of a position with UWC-USA. I also understand that neither this Application for Employment nor any other document constitutes a contract of employment for a specific term and that any employment relationship that may be established will be at-will. As such, any employment relationship I may have with UWC-USA may be terminated at any time, for any reason or no reason, by me or UWC-USA. I understand that no representative of UWC-USA, other than the President, has the authority to enter into any agreement for employment with me contrary to the foregoing. I understand that any omission, misrepresentation, or falsification in conjunction with this application process may be grounds for denial of employment or, if hired, immediate termination of employment. I also understand that any offer of employment, and continued employment, are conditioned upon the satisfactory completion of a background check, including but not limited to, a criminal record check and a motor vehicle records check, as determined in the sole discretion of UWC-USA. I understand that information, data, and records provided or disclosed by or on behalf of UWC-USA or that I otherwise learn in the course of dealing with UWC-USA shall be deemed confidential and/or proprietary information. I understand that no right or license, either expressed or implied, is granted to use or disseminate any confidential and/or proprietary information. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE CERTIFICATION: Signature: Date: Print Name Application must be signed and dated and upon completion can be mailed to the attention of Eileen Saiz, Human Resources Manager, UWC-USA, P.O. Box 248, Montezuma, NM 87701, or faxed to (505) , or ed to Rev d 8/10 5

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