First Name *

MI *

Last Name *

Address *

City *

State *

Zip *

Phone Number *

Alternative Phone Number *

Best Time to Call

Email Address *

Are you of legal age to work?

Job you're applying for: *

Have you selected at least one job above to apply for? *

Job you're applying for (second):

Job you're applying for (third):

Desired salary

How often would you like to work? *

If Part-Time or Temporary Basis, specify days, hours, type of temp work

Date available for work *

Who referred you to Millikin?

Are you legally authorized to work in the United States and willing to provide documentation to prove eligibility?

List any friends or relatives employed by Millikin

Have you been convicted of a felony in the last 7 years? A conviction may not necessarily disqualify an applicant from employment. Applicants are not obliged to disclose sealed or expunged records or information about arrests which did not result in a conviction.

If yes, describe

Name

Address

Course or Major Subject

Dates Attended

Graduated

Degree

Name

Address

Course or Major Subject

Dates Attended

Graduated

Degree

Name

Address

Course or Major Subject

Dates Attended

Graduated

Degree

Name

Address

Course or Major Subject

Dates Attended

Graduated

Degree

Name

Address

Course or Major Subject

Dates Attended

Graduated

Degree

Name

Address

Course or Major Subject

Dates Attended

Graduated

Degree

Ok to contact my employer

Comments

Company Name

Company Address

Employment

Title

Reason for Leaving

Supervisor Name

Supervisor Title

Supervisor Phone #

Duties

Salary

Company Name

Company Address

Employment

Title

Reason for Leaving

Supervisor Name

Supervisor Title

Supervisor Phone #

Duties

Salary

Company Name

Company Address

Employment

Title

Reason for Leaving

Supervisor Name

Supervisor Title

Supervisor Phone #

Duties

Salary

Job relevant skills

Do you have a valid drivers license?

Have you ever been employed at Millikin

If employed, position, dept, supervisor, and dates

Have you ever been discharged, fired, or asked to resign

If discharged, explain

Name

Address

Phone

Position

Name

Address

Phone

Position

Name

Address

Phone

Position

Applicants requiring a reasonable accommodation in completing this application or during the hiring process should contact Human Resources as soon as possible.

I certify the facts set forth in this application for employment and any attachments given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application and attachments as may be necessary in arriving at an employment decision, including permission to contact schools, references, and employers.

I understand that if I am employed, employment will be contingent upon successful completion of a background check. I also understand that false statements, omissions or misrepresentations may result in my dismissal.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the University is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause. It is further understood that this “at will” employment relationship may not be changed unless such change is specifically acknowledged in writing by an authorized executive of the University.

I also understand that if employed I will be required to abide by all policies and procedures of the University.

My signature is evidence that I read, fully understand and accept all terms of the foregoing Statement.

Comments

Signature *

Date *