Name & Contact Information
Give accurate, complete full-time and part-time employment record (up to 7 previous jobs). Start with present or most recent employer. DO NOT STATE "SEE RESUME".
Please list 3 references other than relatives and previous employers.
Adjunct Faculty Information
Complete this section if you served in the U.S. Armed Forces.
Nondiscrimination in Education
It is the policy of Northwest Iowa Community College not to discriminate on the basis of race, color, national origin, sex, disability, age, sexual orientation, gender identity, creed, religion, and actual or potential parental, family or marital status in its programs, activities, or employment practices as required by federal and state civil rights statutes and all other applicable federal and state laws, regulations and orders. The Board of Trustees shall monitor progress on this policy through the President's appointed Affirmative Action/Equity Coordinator(s).
If you have any questions or complaints related to compliance with this policy, please contact one of the Equity Coordinators at Northwest Iowa Community College, 603 West Park Street, Sheldon, Iowa, room D403b or room A101D, email firstname.lastname@example.org, phone number 712-324-5061, extension 113 or extension 137, fax 712-324-4136; or the Director of the Office for Civil Rights, U.S. Department of Education, John C. Kluczynski Federal Building, 230 S. Dearborn Street, 37th Floor, Chicago, IL 60604-7204, Telephone: (312) 730-1560, Fax: (312) 730-1576, TDD: (800) 877-8339, Email: OCR.Chicago@ed.gov.
I certify that the information provided by me in this application is true and complete to the best of my knowledge. I understand that any misrepresentation or omission may be grounds for rejection of my application for current and future employment or for termination if I have been employed.
I acknowledge that it is the responsibility of the College to hire qualified applicants, and that it is the responsibility of the College to make inquiries as the College, in its discretion, deems relevant to assess work performance. I authorize the College, or its agents, to contact references, to investigate my background, and to make such other inquiries as the College deems relevant to assess my qualifications for the position for which I am applying except where my written statement specifically requests that no reference be made. I release all parties from any liability for such disclosure and I understand that the information disclosed will not be released to me.
Finally, I understand that nothing in this application is intended to create an employment contract and that a job offer is not final until all hiring conditions have been
met and all required approvals have been obtained.
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Northwest Iowa Community College Sheldon, Iowa, Employment Policy Statement
Northwest Iowa Community College embraces the concept of nondiscrimination in all areas of human and
personnel relations. Equal opportunity in recruitment, in employment, and in advancement is guaranteed
students, potential students, applicants for employment, and all college personnel regardless ofsex, sexual
orientation, gender identity, color, race, national origin, age, religion, disability, or political affiliate or belief.
Equal Employment Opportunity Survey
The following information is necessary for Northwest Iowa Community College to evaluate its hiring practices
and to prepare reports requested by law for the state and federal government. The information will be confidential and will not be used to make a decision about your employment. Your cooperation by providing the information on a voluntary basis will be appreciated.
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