EMPLOYMENT INFORMATION

POSITION TYPE

WHAT IS YOUR ASSOCIATED HIGH SCHOOL?

PERSONAL INFORMATION

LEGAL FIRST NAME

PREFERRED NAME

LEGAL MIDDLE NAME

LEGAL LAST NAME

DATE OF BIRTH (Ex. 01/15/2020)

SOCIAL SECURITY NUMBER

DRIVER'S LICENSE NUMBER

DRIVER'S LICENSE EXPIRATION DATE (Ex. 01/15/2020)

PERSONAL EMAIL ADDRESS

PHONE NUMBER

MAILING ADDRESS

STREET ADDRESS

CITY

STATE

ZIP CODE

EMERGENCY CONTACT INFORMATION

NAME

RELATIONSHIP

PHONE NUMBER

STATISTICAL INFORMATION

GENDER IDENTITY

PRONOUNS (OPTIONAL)

LEGAL SEX

SEX AT BIRTH (OPTIONAL)

ETHNICITY

RACE

DO YOU SPEAK ANY OTHER LANGUAGES THAN ENGLISH? (OPTIONAL)

WHICH LANGUAGES CAN YOU SPEAK? (OPTIONAL)

EDUCATIONAL INFORMATION

WHAT IS YOUR HIGHEST LEVEL OF EDUCATION ACHIEVED?

WHAT IS YOUR AWARDING INSTITUTION?

KPERS INFORMATION

ARE YOU A CURRENT KPERS MEMBER?

WHAT YEAR DID YOU START?

ARE YOU A KPERS RETIREE?

WHAT DATE DID YOU RETIRE?

By checking this box, I authorize Flint Hills Technical College to conduct a background check, which may include, but is not limited to, verification of my employment history and a review of my motor vehicle records. I understand that any offer of employment is contingent upon the results of this background check, and that the offer may be rescinded if information is found that disqualifies me from employment.