APPLICATION FOR EMPLOYMENT

ARKANSAS TECH UNIVERSITY
RUSSELLVILLE AR 72801
479-968-0396

APPLICATION FOR EMPLOYMENT

Arkansas Tech University considers applicants for all positions without regard to race, color, age, marital or veteran status, the presence of non-job related mental condition or handicap, or any other legally protected status. Arkansas Tech University only accepts applications for vacant positions. An application must be completed for each position you are applying for. Only completed applications with work history will be accepted. The work history section of the application must be completed. We do not accept resume in lieu of completing this section. For vacant positions click here. DO NOT HIT THE ENTER KEY UNTIL YOU HAVE COMPLETED THE APPLICATION.

Date:

PERSONAL

Last Name:
First Name:
Middle Name:
Social Security Number:
Email Address:
Street Address:
City, State, Zip:
Home Telephone:
Business Telephone:
Position Applying for:
Expected Salary:
When are you able to begin work?

Have you ever been employed by ATU? Yes No

If Yes: Year Department

List your skills, training, licenses, or certificates significant to the position:

Proof of U.S. Citizenship or Authorization to work must be provided within 3 days of employment.

Have you ever been convicted of a felony? Yes No

Have you ever served in the U.S. Armed Forces? Yes No Branch:

Dates of duty: From To

EDUCATION

College

Name and Location:
Major:
Years Completed:
Graduation Date:
Degree or Diploma:

Business/Trade/Technical

Name and Location:
Major:
Years Completed:
Graduation Date:
Degree or Diploma:

High School

Name and Location:
Major:
Years Completed:
Graduation Date:
Degree or Diploma:

EMPLOYMENT
Please give accurate, complete full-time and part-time employment record.
Start with your present or more recent employer.

1.	Company Name:

Address:

Telephone:

Name of Supervisor:

Employed From:

Employed To:

Salary Beginning:

Salary Ending:

Job Title and Duties:

Reason for Leaving:

2.	Company Name:

Address:

Telephone:

Name of Supervisor:

Employed From:

Employed To:

Salary Beginning:

Salary Ending:

Job Title and Duties:

Reason for Leaving:

3.	Company Name:

Address:

Telephone:

Name of Supervisor:

Employed From:

Employed To:

Salary Beginning:

Salary Ending:

Job Title and Duties:

Reason for Leaving:

4.	Company Name:

Address:

Telephone:

Name of Supervisor:

Employed From:

Employed To:

Salary Beginning:

Salary Ending:

Job Title and Duties:

Reason for Leaving:

We may contact the employers listed above unless you indicate below those you do not want us to contact.

Employer Number(s)	Reason

REFERENCES

Include at least one character and one technical reference excluding relatives.

Name:

Address:

Telephone:

Business/Occupation:

Name:

Address:

Telephone:

Business/Occupation:

Name:

Address:

Telephone:

Business/Occupation:

Name:

Address:

Telephone:

Business/Occupation:

The information in this application for Employment is true, correct, and complete.
If employed, any misstatement or omission of fact on this application may result in dismissal.

OPTIONAL
EQUAL EMPLOYMENT DATA SHEET

Affirmative Action Information
This data sheet is designed to collect information which will be used in the completion of various state and federal reports and will not be used in the processing of, or remain part of, your application. The completion of this sheet is voluntary.

Applicant Name:
Position Applied For:
Social Security Number:
Date of Birth:
Gender:
Ethnicity:
Are you a U.S. Citizen?:
Are you a Non-Resident Alien?

Military History
If you believe you may be eligible for veterans preference consideration, complete this section. The Arkansas Veterans Preference Act states specific requirements which must be met in order to be eligible for veterans preference. Under certain conditions spouses, widows, or widowers of qualified veterans may also be eligible for veterans preference. For consideration of veterans preference, proof such as a DD-214, current letter from the Veterans Administration, or other official documentation may be required. Specific questions regarding veterans preference should be addressed to individual state agency personnel offices.

Have you served on active duty in the United State military, excluding Active Duty for Training and Reserve Military Annual Training?
Branch of service:
Date of Entry:
Date of Discharge:
Type of Discharge:

How Did You Learn of This Job Opening?

Arkansas Tech University is an Equal Opportunity Employer. It is a policy of this University not to discriminate on the basis of race, color, creed, sex, national origin, age, mental or physical disability of applicants. This is in compliance with all Federal, State, and Local statutes, ordinances, and regulations.

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