Staff Employment Online Application

Please complete and submit the fields below. Your application will be forwarded to our staff.

(* Indicates a required field)

*Today's Date: Feb 07, 2012
*Position Applied for:
*Last Name
*First Name
Middle Initial
*Last 4 digits of SSN
*Address
*City, State, Zip:
*Telephone:
*Alternate address/phone where you may be reached:
*E-mail:
Employment History (please begin with most recent):
*Employer:
*Job Title:
*Dates employed: From:
  To:
*Initial wage:
*Ending wage:
*Employer address:
*City, State, Zip:
*Work performed:
*Reason for leaving:
*Supervisor:
*Telephone:
*May we contact for reference?: Yes No
Employer:
Job Title:
Dates employed: From:
  To:
Initial wage:
Ending wage:
Employer address:
City, State, Zip:
Work performed:
Reason for leaving:
Supervisor:
Telephone:
May we contact for reference?: Yes No
Employer:
Job Title:
Dates employed: From:
  To:
Initial wage:
Ending wage:
Employer address:
City, State, Zip:
Work performed:
Reason for leaving:
Supervisor:
Telephone:
May we contact for reference?: Yes No
Employer:
Job Title:
Dates employed: From:
  To:
Initial wage:
Ending wage:
Employer address:
City, State, Zip:
Work performed:
Reason for leaving:
Supervisor:
Telephone:
May we contact for reference?: Yes No
Employer:
Job Title:
Dates employed: From:
  To:
Initial wage:
Ending wage:
Employer address:
City, State, Zip:
Work performed:
Reason for leaving:
Supervisor:
Telephone:
May we contact for reference?: Yes No
Comments (including any gaps in employment):
 
Acquired Skills:
Typing / words per minute:
Computer: Personal Mainframe
Software:
Word Outlook Excel
DOS Power Point Access
Other Software:
 
Additional information that you feel may be helpful to us in considering your application. Summarize special job-related skills and qualifications:
 
Educational Background (please begin with most recent):
*School:
*Years completed:
*Degree/Diploma:
*Grade Point Average/ Class Rank:
*Major:
Minor:
 
School:
Years completed:
Degree/Diploma:
Grade Point Average/ Class Rank:
Major:
Minor:
 
School:
Years completed:
Degree/Diploma:
Grade Point Average/ Class Rank:
Major:
Minor:
 
Professional References:
1. *Name:
*Telephone:
*Years known:
 
2. *Name:
*Telephone:
*Years known:
 
3. *Name:
*Telephone:
*Years known:
 
Additional Information:
Can you provide proof of eligibility to work in the U.S.? Yes No
State any additional information that you would like us to consider:
 
*Have you been convicted of a felony in the last 10 years? Yes No
If Yes, please explain. (Conviction may be relevant if job related, but does not bar you from employment):
 
*Are you capable of performing in a reasonable manner the activities involved in the job or occupation for which you have applied? Note: Do not answer this question unless you have fully read the job description on the preceding page.
Yes No
 
* Are you related to anyone currently employed at Drury University?
Yes No
If so, please provide name(s)
*How did you find out about this job?
 
I certify that answers given herein are complete to the best of my knowledge.  I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.   In the event of employment, I understand that false or misleading information given in my application, resume or interview(s) may result in discharge.