Academic Employment Application

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Please supply the information below as supplied in the position listing. (View Position Listings)

Name of position for which you are applying

Date you can start

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Are you employed currently?

Yes

No

If so, may we contact your present employer?

Yes

No

Have you previously applied to this University?

Yes

No

In what area?

When?

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Name(Required)

Prefix First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Contact Number(Required)

Alternate Number

Email(Required)

Are you 18 years or older?(Required)

Are you authorized to work lawfully in the United States?(Required)

Will you now, or in the future, require sponsorship for employment Visa status (e.g., H-1B, visa status)?(Required)

If yes, please provide explanation

Have you ever worked at Belmont Abbey College?(Required)

If yes, indicate dates of employment and positions(Required)

Have you ever been convicted of any law violation (except a minor traffic violation)?(Required)

A “yes” answer does not automatically disqualify you from employment, since the nature of the offense, date and the job for which you are applying will also be considered.

If yes, please provide explanation(Required)

Belmont Abbey College is an equal employment employer. It is the policy and practice of Belmont Abbey College to recruit and select applicants on the basis of their qualifications and ability without regard to race, color, religion, national origin, age, sex, disability, or veteran status. This effort is in compliance with all federal and state laws, including, but not limited to, Title VI and VII of the Civil Rights Act of 1964, Title IX of the Educational Amendments of 1972, Section 504 of the Rehabilitation Act of 1975, and the Americans with Disabilities. Applicants are invited to answer the demographic questions below. Information provided by the applicant is confidential and will be used ONLY for statistical compilation. Providing responses is completely voluntary and no applicant will be negatively affected by not providing responses. This information will not be part of the institution's employment decision regarding the applicant, and will not be seen by anyone involved in the hiring decision. Thank you in advance for your time and cooperation.

Gender

Are you Hispanic or Latino?

Race Category

American Indian

Alaskan Native

Black or African American

Asian

Native Hawaiian or Pacific Islander

White

Decline to Answer

Why are you being asked to complete this form? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Please check one of the boxes below

YES, I HAVE A DISABILITY (or previously had a disability)

NO, I DON'T HAVE A DISABILITY

I DON'T WISH TO ANSWER

Your Name

Today's Date

Month

Day

Year

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www. dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Definitions This employer is a Government contractor subject to the Vietnam Era Veteran's Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment; (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows: A “disabled veteran” is one of the following:

A “recently separated veteran” means any veteran during the three year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service. An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval, or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval, or air service, participated in a U.S. military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. Protected veterans may have additional rights under USERRA – the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll free, at 1-866-4-USA-DOL.

Self-Identification As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each year identifying the number of our employees belonging to each specified “protected veteran” category, If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below.

Self Identification

I belong to a classification of protected veterans

I am a protected veteran, but I choose not to self-identify the classifications to which I belong.

I am NOT a protected veteran.

Protected Veteran Classification

DISABLED VETERAN

RECENTLY SEPARATED VETERAN

ACTIVE WARTIME OR CAMPAIGN BADGE VETERAN

ARMED FORCES SERVICE MEDAL VETERAN

Choose all that apply.

Military Discharge Date

Month

Day

Year

Type Full Name

Today's Date

Month

Day

Year

If you are disabled veteran if would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended. The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

How did you hear of this employment opportunity?

Belmont Abbey College website

Catholicjobs.com

Higheredjobs.com Website

Professional Affiliation Website

Advertisement in Academic or Professional Publication

Referred by a current or former employee

Conference or career fair

Other

Current or former employee who referred you.

Please note: To upload multiple documents of the same type, i.e. two transcripts, you must combine the documents into a single PDF or Word document before clicking on the “browse” button, or use the “Other Documents” option. (If applicable)

Document Upload(Required)

Drop files here or

Max. file size: 70 MB.

I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause and with or without notice. By selecting the check box below, I assert that all information given in this application is true. I understand that false information (misrepresentation or omission of information) may be the basis for disqualification or termination of employment. I authorize investigation of all statements contained herein.

(Required)

I certify that I have read and agree with these statements

Type Full Name(Required)

Today's Date(Required)

Month

Day

Year