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Personal Information

First Name *

Last Name *

Middle Name

Maiden or Other Surname

Title

Phone *

Email Address *

Confirm Email Address *

Type of Employment *

Faculty

Staff

Temporary

Desired Position(s) *

Full Time

Part Time

Date Available * +

Are you legally authorized to work in the United States on an unrestricted basis? *

Yes

Please explain *

Have you ever been convicted of a felony? *

Yes

What was your sentence? *

Education

Please list each educational institution attended beginning with the most recent. Attach an additional sheet if needed.

Institution #1

Dates Attended

From +

To +

Institution Name

Graduated?

Yes

Degree Earned

Major Area of Study

Institution #2

Dates Attended

From +

To +

Institution Name

Graduated?

Yes

Degree Earned

Major Area of Study

Institution #3

Dates Attended

From +

To +

Institution Name

Graduated?

Yes

Degree Earned

Major Area of Study

Attach Copy of Official Transcript(s) *

Note: you may upload up to 10 files.

Employment History

Please provide your employment history or attach a resume. The employment history or attachment (resume) is required to submit the application.

Start with your present or most recent employment and work back. (Include paid and unpaid positions)

Attach Resume *

Are you currently employed? *

Yes

Employer #1

Start Date +

End Date +

Job Title

Company Name

City

State

Zip

Supervisor/Manager

Supervisor's Contact Information (Email or Phone)

Duties

Reason for Leaving

Starting Salary

Ending Salary

May we contact your present employer? *

Yes

Employer #2

Start Date +

End Date +

Job Title

Company Name

City

State

Zip

Supervisor/Manager

Supervisor's Contact Information (Email Or Phone)

Duties

Reason for Leaving

Starting Salary

Ending Salary

Employer #3

Start Date +

End Date +

Job Title

Company Name

City

State

Zip

Supervisor/Manager

Supervisor's Contact Information (Email or Phone)

Duties

Reason for Leaving

Starting Salary

Ending Salary

Employer #4

Start Date +

End Date +

Job Title

Company Name

City

State

Zip

Supervisor/Manager

Supervisor's Contact Information (Email or Phone)

Duties

Reason for Leaving

Starting Salary

Ending Salary

Explain any gaps in your employment history.

Certifications/Licenses

Professional License or Certification

Expiration date +

Professional License or Certification

Expiration date +

Professional License or Certification

Expiration date +

Attach Licenses and Certifications

Note: you may upload up to 10 files.

Other Relevant Experience

List any additional experience not included above or on the resume you uploaded that is important for the position(s) you are seeking.

Attach relevant documentation for relevant experience

Note: you may upload up to 10 files.

Verification of Qualification

Please attach the following items to document your Education, Experience, Other Relevant Experience, and Certifications/Licenses included above using the appropriate links below.

Record of accomplishments in previous other relevant educational work settings (Attach letter of qualification)

Relevant occupational training (Attach supporting documentation)

Note: you may upload up to 10 files.

References

Please include the name and contact information for professional references.

	References	Phone Number	Email Address
1.	References	Phone Number	Email Address
2.	References	Phone Number	Email Address
3.	References	Phone Number	Email Address

Disclaimer and Signature

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize Virginia University of Lynchburg to verify any of the facts set forth in this application and release Virginia University of Lynchburg from any liability. Virginia University of Lynchburg may contact any listed references on this application.

I acknowledge and understand that Virginia University of Lynchburg is an “at will” employer. Therefore, any employee (faculty, staff, regular, temporary, or other type of category employee) may resign at any time, just as Virginia University of Lynchburg may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

Signature of Applicant: *

Date * +

Note: You will receive a confirmation email upon submitting your application.