Jenzabar University

Application for Employment

Human Resources

3301 West 18th Avenue | Emporia, KS 66801-5957

620.341.1384 | 800.711.6947 | fax: 620.341.1320

Answer all questions that apply to you. If not applicable, type N/A.  Do not indicate "See Resume". A resume may be emailed to HR@fhtc.edu or uploaded on the resume tab to provide additional supporting information. An incomplete application may delay processing or may not be considered for employment.

Legal Name

First Name

Middle Name

Last Name

Preferred Name

Other last names under which your records may be found

Mailing Address

City

State

Zip

Contact Information

Telephone where you may be contacted:

Phone Type

Email Address

Would you like to provide a Cover Letter, Resume or College Transcript?

Cover Letter

Resume

College Transcript

Position applying for

Types of teaching/training qualified to conduct. (Instructional positions only)

Type

Expiration Date

Type

Expiration Date

Type

Expiration Date

Type

Expiration Date

High School Diploma or equivalent

If no, indicate highest grade completed

Names of Colleges or Universities attended (List most recent education first)

Major

Minor

Degree Earned

Major

Minor

Degree Earned

Major

Minor

Degree Earned

Major

Minor

Degree Earned

Do you have any prior work experience?

Provide complete employee history information for all employment. Begin with present or most recent employment. Please send additional employment history to HR@fhtc.edu.

First Employer

Name of Employer

City

State

Phone

Position

Immediate Supervisor

Current/Final Salary

Dates Employed

From

To

Duties

Reason for leaving

Full Time or Part Time

May we contact your supervisor?

Second Employer

Name of Employer

City

State

Phone

Position

Immediate Supervisor

Current/Final Salary

Dates Employed

From

To

Duties

Reason for leaving

Full Time or Part Time

May we contact your supervisor?

Third Employer

Name of Employer

City

State

Phone

Position

Immediate Supervisor

Current/Final Salary

Dates Employed

From

To

Duties

Reason for leaving

Full Time or Part Time

May we contact your supervisor?

List all of the valid professional licenses and registrations you hold. Include the certification/registration number and the date of expiration.

Indicate other employment skills, special training or related courses that you would like considered as part of your application.

Describe significant contributions and achievements, including publications or awards, in professional and/or civic activities that you would like considered as part of your application.

Are you at least 18 years of age?

Are you an active member of the Active Duty Forces, National Guard or Reserved Forces?

Have you been employed by Flint Hills Technical College?

If yes, when?

Do you currently have funds vested with the Kansas Public Employees Retirement System (KPERS)?

Are you legally authorized to work in the Unites States?

*As required by federal law, Flint Hills Technical College will hire only United States citizens and aliens authorized to work in the United States.  All new employees will be required to complete an "Employment Eligibility Verification" (Form I-9) and produce required documentation after employment. A list of documents acceptable for proof under the Immigration Reform Act of 1986 is available upon request.

Have you been convicted of, or pleaded "no contest" to, any felony or misdemeanor criminal offense(s) excluding traffic offenses?

If yes, please briefly explain? (A "Yes" response will not automatically disqualify you from employment.)

Have you ever had your driver's license suspended or restricted for any reason?

If yes, please briefly explain? (A "Yes" response will not automatically disqualify you from employment.)

Please briefly elaborate on your work experience.

First Reference

Name of Reference

Organization

Title

Street Address

City

State

Zip

Phone

Second Reference

Name of Reference

Organization

Title

Street Address

City

State

Zip

Phone

Third Reference

Name of Reference

Organization

Title

Street Address

City

State

Zip

Phone

I hereby certify that all information on or in connection with this application and attachments thereto is true and complete to the best of my knowledge and I have not knowingly withheld any fact or circumstance. By electronic signature below, I authorize the representative of Flint Hills Technical College to contact any of my schools, former or current employers or other references needed to provide applicable information to the position sought.  I authorize any and all persons contacted by the College to disclose fully all information available to such persons, whether on record or not, which may have a bearing on my application or my employment.

I understand that if employed, any misrepresentation of the facts as stated or implied on this application is sufficient cause for dismissal. The application does not bind me or the College for any specific period of employment and I understand that nothing in this application creates any contractual obligation of any kind for either party. If employed, I agree to comply with all policies, procedures and regulations of Flint Hills Technical College and applicable local, state and federal laws as currently exist or as may exist in the future.

Furthermore, I understand that I can access FHTC Campus Safety and Security Reports at fhtc.edu and can contact Vice President of Student Services, Lisa Kirmer at lkirmer@fhtc.edu with any questions regarding Campus Security.

"Under the Uniform Electronic Transactions Act (K.S.A. 16-1601 et seg.), a document sent electronically may be considered an electronic record. If you wish to submit your Employment Application Form electronically, select Yes I understand, type your name and select the date below. In so doing, you are hereby certifying that this electronic submission shall be given the same legal effect as a handwritten signature."

Applicant's Signature (Please enter full legal name)

Date

Information provided on the application will become part of your permanent personal record if you are employed by Flint Hills Technical College. Materials submitted for consideration as part of an application for employment are not returnable. A resume or other appropriate materials may be included with the application.  Copies of college transcripts may be required as part of the application.

Non-Discrimination Notice: To promote equal employment, advanced and learning opportunities to all individuals, employment and student admissions at Flint Hills Technical College will be based on merit, qualifications and abilities. Flint Hills Technical College does not discriminate on basis of any characteristic protected by law in all aspects of employment and admission in its education programs or activities. Any person having inquiries concerning Flint Hills Technical College's non -discrimination policy, including the application of Equal Opportunity Employment, Titles IV,VI,VII, IX, Section 504 and the implementing regulations, is directed to contact the College's Human Resources Department,

Flint Hills Technical College, 3301 West 18th Avenue, Emporia, KS 66801 620.341.1384. Any person may also contact the Director, Office of Civil Rights, U.S. Department of Education, Washington, DC 20201