Applicant Name:
		Position Title(s):		Job Number(s):
		Date:
	San Juan College APPLICATION Changing people’s lives since 1956.
			4601 College Boulevard
			Farmington, New Mexico 87402-4699
			(505) 566-3215, FAX (505) 566-3521
			www.sanjuancollege.edu

IMPORTANT INFORMATION FOR THE APPLICANT San Juan College is pleased that you are interested in submitting an application for employment. It is important for you to understand the employment policies and procedures relating to the selection of Human Resources at the college. Current college policy requires a completed application. Please review the minimum qualifications for the job you are applying for and complete all questions and sections of the application. Answer all questions completely and accurately. False statements are cause for refusal of application, removal from consideration, or dismissal from a position. Be sure that you include any supporting documents required in the position announcement. Transcripts should be submitted with the application if you have had college course work. A resume may be attached, but is not accepted in lieu of a completed application. The College Human Resources Office encourages applicants to submit a current resume with the application. We will accept unsolicited applications, and maintain these applications in our file for a minimum of six months. Non-selected candidates’ applications and unsolicited applications are not automatically transferred from the general file to a posted position pool. If an applicant is informed of another open position, the applicant must contact the Human Resources Office and request that his/her application be moved to the advertised position’s pool of applicants. Any address or phone number changes must be forwarded to the Human Resources Office to maintain eligibility for employment. San Juan College posts available positions in the Human Resources Office, on our web site (www.sanjuancollege.edu) and on our job line (505) 566-3448. We also advertise in the Farmington Daily Times and in the Navajo Times. Professional, faculty and administrative positions, in most cases, are also advertised nationally in the Chronicle of Higher Education, Community College Week and Community College Times. San Juan College abides by all state and federal nondiscrimination and equal opportunity requirements. It should be noted that the Equal Employment Opportunity data form requested on the next page of this application is not used in the review of materials for the selection of candidates. Please inform a Human Resources Office staff person if, as a result of a disability, you require any reasonable accommodation related to the application or interview process within a reasonable time period. Again, thank you for your interest in San Juan College. If you need any further information, or have any questions about the application process, open positions, or other employment issues, please call us at (505) 566-3215. Our fax number is (505) 566-3521.

Please complete the Equal Employment Opportunity information requested on the next page of this application.

Equal Employment Opportunity San Juan College is in agreement with the philosophy of equal employment and educational opportunities. San Juan College will comply with existing federal and state laws and regulations in its Human Resources actions, including the Title VII Civil Rights Act of 1964 and 1990; Executive Order 11246; Section 504 or the 1973 Rehabilitation Act; the Age Discrimination Act of 1967, the Americans with Disability Act of 1990, as amended, and the Vietnam Era Veteran’s Readjustment Act of 1974. It is the policy of the College to provide for equal opportunity in recruitment, employment, compensation, benefits, transfers, layoffs, returns, institutionally sponsored education, training, tuition assistance, social and recreational programs, staff development opportunities and advancement, and all other Human Resources practices without regard to race, color, religion, national origin, ancestry, sex, disability, age, or veteran’s status.
EEO Administrator/Vice President for Fiscal Services San Juan College 4601 College Blvd. Farmington, NM 87402
Based upon federal reporting requirements with which San Juan College must comply, we are requesting that you provide us with the information requested below. The information will be used for statistical purposes only and will be retained independent of your application. Refusal to supply the information requested will not subject the applicant to any adverse treatment. Submission of information is voluntary and will be kept confidential.
Name: Phone: ( )- -
Address:
Position Applied for: Date:
Check all of the following that apply to you:
Female		White (1)		Hispanic (3)		Asian or Pacific Islander (5)
Male		African American (2)		Native American or Alaskan Native (4)		Disabled
		How did you learn of this position?
		Newspaper	Job Service Center		Other
		Friend	Walk-In		Internet (Web)
	Please read previous page for important information.

SAN JUAN COLLEGE EMPLOYMENT

Social Security #:

Name:

Last

First

Middle

Mailing Address line 1:

Mailing Address line 2:

City:

State:

Zip:

( ) -

( ) -

( ) - ext.

( ) -

Home Phone

Cell Phone

Work Phone (Optional)

Cell Phone

Email Address:

Check what type of work you will accept:

Full-Time

Shift Work

Temporary

Part-Time

Night Work

Name of relatives employed by San Juan College:

Have you been convicted of a felony? No If Yes, when?

Are you eligible to be employed in this country? Yes No

(Proof of citizenship or verification of employment status will be required upon enrollment)

Please state the type of work Visa you possess:

Work Visa expiration Date:

EDUCATION
NAME AND LOCATION (City & State) OF HIGH SCHOOL ATTENDED			Graduated? Yes No
			If yes, what year?				If no, highest grade completed?
			GED Issued by:				Date Issued
NAME & LOCATION OF COLLEGE OR UNIVERSITY (If you expect to earn a degree in next 3 months, give time you expect degree and circle.)	Credit Hours Completed	Dates			Graduation Date	Type Of Diploma Or Degree		Major/Minor
		FROM		TO

License/Certification (CPA, RN, Etc.)	Date Issued	Issuing Authority	License No.	Location of Issuing Authority (city & state)
Driver’s License (provide only if required for the position) State Number Expiration Date
List special skills and/or equipment you can use or any other information not covered elsewhere which relates to your eligibility for the position.

COMPLETE THIS SECTION IF YOU SERVED IN THE U.S. ARMED FORCES		Branch of Service
Describe your duties and any special training:		Period of Active Duty (Month & Year) From To
		Rank at Discharge
		Date of Final Discharge
Are you currently under contract with any other educational institution?		Yes	No
If yes, are they informed of this application? Yes No	Explain

Employment History

List your employment history starting with the most recent job, including part-time, temporary, and volunteer jobs. Under “Duties,” describe clearly the tasks you performed and the nature of your supervisory, technical. Or other responsibilities as they relate to the job for which you are applying. Be complete and specific in detailing of duties. A resume will not be accepted in lieu of the application.

May we contact your current employer? Yes No

PRESENT OR LAST EMPLOYER	TELEPHONE ( ) -	FROM: / / MO. DAY YR. TO: / / MO. DAY YR. HRS. PER WEEK: SUPERVISOR’S NAME & TITLE:
ADDRESS
YOUR TITLE
DUTIES

PRESENT OR LAST EMPLOYER	TELEPHONE ( ) -	FROM: / / MO. DAY YR. TO: / / MO. DAY YR. HRS. PER WEEK: SUPERVISOR’S NAME & TITLE:
ADDRESS
YOUR TITLE
DUTIES
PRESENT OR LAST EMPLOYER	TELEPHONE ( ) -	FROM: / / MO. DAY YR. TO: / / MO. DAY YR. HRS. PER WEEK: SUPERVISOR’S NAME & TITLE:
ADDRESS
YOUR TITLE
DUTIES
PRESENT OR LAST EMPLOYER	TELEPHONE ( ) -	FROM: / / MO. DAY YR. TO: / / MO. DAY YR. HRS. PER WEEK: SUPERVISOR’S NAME & TITLE:
ADDRESS
YOUR TITLE
DUTIES
PRESENT OR LAST EMPLOYER	TELEPHONE ( ) -	FROM: / / MO. DAY YR. TO: / / MO. DAY YR. HRS. PER WEEK: SUPERVISOR’S NAME & TITLE:
ADDRESS
YOUR TITLE
DUTIES

REFERENCES: List three persons who are not related to you and who have definite knowledge of your qualifications for the position you are applying for. Do not repeat names of supervisors listed under work history.
NAME	ADDRESS/TELEPHONE	POSITION

APPLICANT’S CERTIFICATION AND AGREEMENT

I hereby declare the information provided by me in this Application of Employment is true, correct and complete to the best of my knowledge. I understand that if employed, and misstatement or omission of fact on this application shall be considered cause for dismissal. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. An offer of employment is valid only after approval has been given by the appropriate administrative Human Resources.

Signature Date