Professional Documents
Culture Documents
FACULTY APPLICATION
5000 ROCKLIN ROAD
ROCKLIN CA 95677
An Equal Employment Opportunity/Affirmative Action Employer
This application will be used by a committee to select applicants for interviews; it is our first contact with you
as an applicant for employment. Please print in ink or type your responses completely and accurately. Print
"N/A" on any section that is not applicable. You may respond to the sections on attachments using a word
processor, as long as your responses are clearly labeled and in the same format as established by this
application. Resumes and other relevant documents may be included with your application materials.
Resumes are not accepted in lieu of this application. If this application is unsigned it will be given no
further consideration. Please follow all instructions carefully. You must complete all sections of this
application in order to be considered for this position.
Return this form to the Sierra College Personnel Office prior to the closing date and time stated on the job
opportunity announcement.
Name
____________________________________________________________________________
Last
First
Middle
Address
____________________________________________________________________________
Number
Street
____________________________________________________________________________
City
State
ZIP
Home Phone
__________________________
Message Phone
__________________________
FACULTY APPLICATION
Page 2
NO
____
____
NOTE:
Copies of transcripts must be attached or submitted by the closing date and may be accompanied by
(Photocopies accepted)
____
____
The following applies only if you checked NO in BOTH minimum qualifications and credentials in the subject
area.
____
____
(If you check yes in this category, contact the Personnel Office for procedures to document your claim
of equivalency and submit documentation with your application).
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FACULTY APPLICATION
Address _______________________________________________________________________________
Dates of Attendance
From ________/________/_______
To ________/________/________
Major______________________
Minor______________________
From ________/________/_______
To ________/________/________
Minor______________________
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FACULTY APPLICATION
If more space is needed, use attachments, clearly labeled and in the same sequence and format.
Address _______________________________________________________________________________
To ________/________/________
Course/Topic __________________________________________________________
Address _______________________________________________________________________________
To ________/________/________
Course/Topic __________________________________________________________
Address _______________________________________________________________________________
To ________/________/________
Course/Topic __________________________________________________________
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FACULTY APPLICATION
Address ______________________________________________________________________________
Full-Time _____
Position: ______________________________________________________________________________
To _______________________
No. of Semesters
______________________________________________________________
_____________
______________________________________________________________
_____________
______________________________________________________________
_____________
______________________________________________________________
_____________
Institution/District ______________________________________________________________________
Address ______________________________________________________________________________
Full-Time _____
Position: ______________________________________________________________________________
To _______________________
No. of Semesters
______________________________________________________________
_____________
______________________________________________________________
_____________
______________________________________________________________
_____________
______________________________________________________________
_____________
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FACULTY APPLICATION
Address________________________________________________________________
Position ________________________________________________________________
Full-time ________
Dates:
From _________________
To ____________________
Employer/Organization____________________________________________________
Address________________________________________________________________
Position ________________________________________________________________
Full-time ________
Dates:
From _________________
To ____________________
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FACULTY APPLICATION
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FACULTY APPLICATION
On an attachment of no more than three (3) pages, address the following. Relate your responses to
the subject areas given in the job description contained in the job opportunity announcement for the
position for which you are applying. (If more space is needed, use attachments, clearly labeled and in the
same sequence and format).
A.
B.
C.
Describe how your education, training (Section II), experience (Section III), other related work
experience (Section IV), and/or professional activities (Section V) enable you to do the job which
you are applying. Please use specific examples and do not refer to See attached resume.
D.
Describe how your background and experiences have prepared you to work in a diverse academic
environment where the student body varies widely with regard to socioeconomics, cultural/ethnic
backgrounds, linguistics and physical/developmental disabilities.
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FACULTY APPLICATION
SECTION VII: References: Names and addresses of persons who are familiar with your previous
educational and/or employment experience whom we may contact.
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FACULTY APPLICATION
SECTION VIII(a): Certification: It is mandatory that you provide the information in this section. It will be used
solely for legal suitability purposes.
YES NO
Have you ever been discharged or forced to resign from a position? (If your answer is yes,
please explain in detail on a separate sheet of paper, and include dates, places, and the nature
of each event).
Federal Immigration laws (Immigration Reform and Control Act of 1986) require employers to
verify and attest to the employment eligibility of new employees to work in the United States.
This requirement applies to all applicants. Are you legally authorized to work in the United
States?
________________________________________
SIGNATURE
______/______/______
DATE
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FACULTY APPLICATION
SECTION VIII(b): Criminal History Statement: It is mandatory that you provide the information in this section. It
will be used solely to determine employment eligibility.
All employment offers are subject to a background clearance which includes, at a minimum, a careful evaluation of criminal
history information to ensure prospective employees are clear of any criminal history that would indicate a risk to the safety or
security of the campus community. The District will not deny employment to any applicant solely because the person has been
convicted of a crime. The District, however, may consider the nature, date, and circumstances of the offense as well as whether
the offense is relevant to the duties of the position. All applicants who are offered employment will be provided with a LiveScan
Request form and be required to submit fingerprints electronically at a California Department of Justice LiveScan Station. The
applicant is required to bear the cost of the LiveScan (typically $42).
#1.
Have you ever been convicted (including a plea of guilty or no contest which resulted in a criminal conviction)
of a crime? (Exclude misdemeanor convictions for marijuana-related offenses more than two years old;
notwithstanding any of the preceding, you should not disclose convictions that are over two years old as of
the date that you complete this application for violation of health and safety code sections 11357, 11360, 11365
or 11550, as those statues related to marijuana prior to January 1, 1976 or a statutory predecessor to those
statutes.)
YES
NO
#2.
List details of each conviction including offense date, arresting agency, code section
violated and date probation ends or ended. Use other side of paper if more space is
needed.
Offense Date
Arresting Agency
Date Probation
Ends or Ended
#3.
By signing below, I certify that I have listed all of my criminal convictions except for those exempted by law. I
understand that if I provide false information about a conviction or fail to disclose a conviction I will be
disqualified for employment. I further understand that if a substantive error or omission of a conviction is
revealed after employment begins, I will be subject to immediate dismissal for cause.
___________________________________________
____________________________
Signature
Date Signed
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FACULTY APPLICATION
The information on this form is for statistical purposes only. Your cooperation in providing the requested information is appreciated.
This information is kept separate and confidential and is not provided to the selection committee. Completion of this form is
voluntary and will neither enhance nor detract from your opportunity for employment with Sierra College.
POSITION TITLE:
__________________________________________________________
Male
______
Female
_______
ASIAN/PACIFIC ISLANDER:
Asian Indian
East Indian/Pakistani: (Origins in any of the original peoples of the Indian sub-continent)
West Asian: (Origins of West Asian Americans from the Afghan, Arabian, Iranian, and Turkish Countries)
___ Cambodian
__ Guamanian
__ Hawaiian
__ Japanese
__ Korean
__ Laotian
__ Samoan
__ Vietnamese
Latin American/Latino: (Persons of Latin American, South American, Cuban, Puerto Rican culture, regardless of race)
Other Hispanic/Spanish: (Persons of Spanish culture or origin, not included in any of the other Hispanic categories above)
(Please Specify
)
WHITE/CAUCASIAN: (Origins in any of the White racial or ethnic groups of Europe, North Africa, or the Middle East)
VIETNAM-ERA VETERAN: (Person who served on active duty for a period of more than 180 days, any part of which occurred between 8/5/64
and 5/7/75, and was discharged or released with other than a dishonorable discharge, or was discharged or released from active duty for a
service-connected disability, if any part of such active duty was performed between 8/5/64 and 5/7/75)
DISABLED VETERAN: (Person entitled to disability compensation under laws administered by the Veteran's Administration for Disability)
__
__
EdJoin
Friend or Colleague
Job Line
Professional Organization (Please specify
Self-Initiated
Special Recruitment
Vacancy Announcement
Other (Please specify