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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.    DO NOT HIT THE ENTER KEY UNTIL YOU HAVE COMPLETED THE APPLICATION.

Date:

PERSONAL
Last Name:
First Name:
Middle Name:
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.
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.
1. 

Name:

Address:
Telephone:
Business/Occupation:
2.

Name:

Address:
Telephone:
Business/Occupation:
3.

Name:

Address:
Telephone:
Business/Occupation:
4.

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.
 
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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Russellville, Arkansas 72801 USA | For general information call 479-968-0389
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