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Employment Application Form: Indiana University Is An Equal Opportunity/Affirmative Action Employer

The document is an employment application for Indiana University which requests basic personal information such as name, address, eligibility to work, and asks the applicant to disclose any prior criminal convictions along with certifying that all information provided is true; it also notes that IU conducts criminal background checks on all new employees and follows equal opportunity policies. The application requests work history, education details, skills, and has the applicant sign agreeing they understand the conditional nature of any employment offer.

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Fritz Prejean
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31 views2 pages

Employment Application Form: Indiana University Is An Equal Opportunity/Affirmative Action Employer

The document is an employment application for Indiana University which requests basic personal information such as name, address, eligibility to work, and asks the applicant to disclose any prior criminal convictions along with certifying that all information provided is true; it also notes that IU conducts criminal background checks on all new employees and follows equal opportunity policies. The application requests work history, education details, skills, and has the applicant sign agreeing they understand the conditional nature of any employment offer.

Uploaded by

Fritz Prejean
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Employment Application Form UHRS 3/2012

Indiana University is an Equal Opportunity/Affirmative Action Employer.

Name (print)
(Last) (First) (Middle)

Are you over 18 years of age? yes no Notice:


Indiana University is an Equal Opportunity/Equal Access/Affirmative
If required for the position, do you hold a valid drivers license? yes no Action institution. IU intends to maintain an alcohol and drug-free
workplace and to comply with the Drug Free Workplace Act of 1988
Are you legally authorized to work in the United States? yes no and its amendments. To that end, all employees must comply with the
Universitys Substance Free Workplace policy. Annual security and fire
Are you a current Indiana University employee? yes no safety reports containing policy statements and crime and fire statistics
for Indiana University campuses are available at protect.iu.edu/police/
If yes, date started, position, and location crimestats/.

Please read and sign the following statement:


I certify that all information provided in all my application material is true.
Have you ever been employed by Indiana University in the past? yes no I understand that any false statement made herein is sufficient reason for
rejection of this application or termination of subsequent employment
If yes, your name (if different), date started and left, position, and location regardless of date of discovery. I authorize the university to investigate all
statements made in my application material for employment. I authorize
such educational institutions and employers and others (and their agents
or employees) to respond to questions concerning information given in
this application material and I further release from liability such former
employers, institutions, or persons providing such information to the
Have you ever been convicted of a crime other than a minor traffic violation? yes no university.
Convicted means you were declared guilty by a judge or you pleaded guilty in court. A conviction may I understand that an offer of employment from Indiana University will be
have even taken place if you did not pay a fine or spend time in jail or in prison. A conviction could have contingent on the receipt and evaluation of the background check report.
been for either a misdemeanor or a felony. For IU purposes, driving while under the influence, driving Disclosure of convictions within this application does not automatically
on a suspended license, reckless driving, leaving the scene of an accident, and vehicular homicide are
not minor traffic violations and must be declared (whether the result is a ticket or a more severe pen-
diqualify me for employment; however, information obtained from the
alty). Minor traffic violations that result in tickets do not need to be declared. A criminal history inves- investigation will be used in the employment review process.
tigation is done on each new employee, and employment with the University is conditional, subject to I agree that the university may require my participation in and contribution
the findings of a criminal history investigation. Answering yes to this question does not automatically to retirement programs while employed. I also understand that the direct
disqualify you for employment; however, information obtained from the investigation will be used in
the employment review process.
deposit of my paycheck to my personal checking or savings account is a
condition of employment. I understand that no offer of benefits such as
If yes, you must disclose for each offense: date, charge, city, state and disposition: a pension plan, insurance, vacation, or salary rate is final until cleared by
(Include type of offense (e.g., misdemeanor, felony) and judgement (e.g., guilty, conditional dismissal).)
Human Resources, and fully approved by appropriate university officials.
I have carefully read and understand this statement and, by my signature
below, note such.

All questions and statements must be answered in full or your application will not be processed. (Signature of Applicant) (Date)
Name (print)
(Last) (First) (Middle)

Address
(Street) (City) (State) (Zip code)

Phone #s E-mail
(Home) (Business) (Cell)

What type of work will you accept? (check all that apply)
Full Time Part Time Days Professional Maintenance Custodial IT/computer
Temporary Seasonal Evenings Dining Service Clerical Technical Other (please specify)
Weekends
EDUCATION
Highest Grade University or College Major/Degree
Name City State Completed Graduated? and year obtained for verification purposes only
High School
or GED yes no
University
or College yes no
University
or College yes no
University
or College yes no

WORK HISTORY
List your work history for at least the past seven years. Begin with the most recent position. A supplemental work history form is available if needed.
From To Name of Firm Address Duties Involved Supervisor Salary Reason for Leaving

Special skills/foreign languages/certifications/licenses

Special equipment/computer hardware or software/industrial machinery/video or teleconferencing

UHRS 3/2012

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