Employment Application RETURN THIS FORM TO: HUMAN RESOURCES WOR-WIC COMMUNITY COLLEGE SALISBURY MD FAX: (410)

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2 Employment Application RETURN THIS FORM TO: HUMAN RESOURCES WOR-WIC COMMUNITY COLLEGE SALISBURY MD FAX: (410) Received Reactivate Reactivate For Office Use Only Date Position Please type or use black ink to complete. Your application may not be considered if you fail to complete all sections of this form completely and accurately. Resumes are encouraged but will not be accepted in lieu of the application. To view open positions, visit Position applying for: Full-Time Administrative Part-Time Administrative Full-Time Faculty* Full-Time Support Staff Part-Time Support Staff Day Evening Source of Referral: Internet Careerbuilder.com Delmarvanow.com HigherEdJobs.com Other Newspaper Daily Times Ocean City Today Star Democrat Other *Applicants interested in teaching part-time must complete a part-time credit faculty or part-time continuing education instructor employment application form. Magazine or Trade Journal (please specify) Wor-Wic Employee or Friend Last Name First Middle (please specify) Current Address Permanent Address (if different from current address) Home Phone: ( ) Business Phone: ( ) Cell Phone: ( ) Have you ever worked at Wor-Wic Community College before? Are you under 18 years old? If yes, do you have a work permit or legal authorization to work? If hired, can you provide written evidence that you are authorized to work in the U.S.? Have you ever been convicted by a court of law, fined or forfeited collateral for breach or violation of any law, police or traffic regulation other than minor traffic violations? (TE: drunken driving, reckless driving and hit-run driving are not minor traffic violations.) If your answer is, please attach an explanation. Have you ever been dismissed or asked to resign from a job? If, please give an explanation below. Wor-Wic Community College is an equal opportunity employer and does not discriminate on the basis of age, gender, race, color, religion, national origin, marital status, sexual orientation, genetic information or disability. If you believe that any of these factors have entered into the consideration of your application for employment, contact the Director of Human Resources at (410)

3 EDUCATION Name and Location of High School: Did you graduate from high school or receive a GED? Name and Location of Educational Institutions Attended Beyond High School Total Credit Hours Earned Degree Earned? (Y/N) Type of Degree (ie., B.S., B.A., etc) Major *Please have official college transcripts and copies of any certificates and licenses forwarded to Human Resources. For Wor-Wic Community College courses and/or degrees: By signing this application, I authorize the release of my official Wor-Wic transcript to Human Resources. List any special courses, skills (i.e.: typing, computer software, bookkeeping, mechanical or other types of equipment you can operate), additional training, licenses, continuing education certificates, awards or honors that relate to your ability to perform the job for which you have applied:

4 EMPLOYMENT RECORD In the following spaces, please provide your complete record of employment starting with your present or most recent position (do not write refer to résumé ). Attach additional sheet (s) if necessary.

5 EMPLOYMENT RECORD (cont'd) If ever employed by a maiden name or other name (s), please indicate below: APPLICANT S ACKWLEDGMENT I certify that answers given in this application are true and complete to the best of my knowledge. I authorize investigation into all statements I have made on this application as may be necessary for reaching an employment decision. In the event I am employed, I understand that any false or misleading information I knowingly provided in my application or interview (s) may result in dismissal and/or legal action. I understand that neither this document nor any offer of employment from this employer constitutes an employment contract. I also understand that if employed, I am required to abide by all rules and regulations of the employer and any special agreements reached between the employer and me. In addition, I understand that federal law prohibits the employment of unauthorized aliens and that I must submit satisfactory proof of employment authorization and identity within three days of employment. Failure to submit such proof will result in dismissal. I hereby authorize and direct any or all of my former employers (individuals, companies, institutions or others) to furnish Wor-Wic Community College with any information concerning my employment that they have on record or otherwise and hereby release these former employers, Wor- Wic Community College and all individuals associated or connected with them from all liability for any damages incurred in furnishing such information. I understand this application will be active for a period of one year and I must contact human resources if I am interested in an open position during this time period. I must submit a new application after the one year time period has expired. SIGNATURE OF APPLICANT: DATE: Revised 03/10