Application for Employment Application for Employment PersonalName* First MI Last Maiden/AKA Date of Application* MM slash DD slash YYYY Current Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Dates of Residence (from-to)* Home Phone*Business PhoneCell/Message/Other PhoneEmail* Preferred method of contact Select All Phone call Text Email Can leave voicemail Position(s) Desired (DO NOT LIST 'ANY')* Pay Expected* Date Avaliable* MM slash DD slash YYYY Please check all applicable options:* Full-Time Part-Time Temporary Full-Time Temporary Part-Time Are you authorized to work in the U.S.?* Yes No Proof of eligibility to work in the U.S. is required upon employmentDo you have any relatives who work for Brescia University? If yes, please give name and relationship:* How did you learn of this opening?* EducationEducation Information*School (High School, College/University, Other)Name and Location of SchoolCourse of StudyNo. of Years CompletedGraduated (Yes/No)Degree or Diploma Recieved Please click the plus sign to add more rows.SkillsOffice Skills* Computer Keyboarding Bookkeeping Payroll None Maintenance Skills* Custodial Carpentry Plumbing Electricity Grounds None Job Related Licenses or CertificatesType Exp. Date MM slash DD slash YYYY Professional Organization Membership(s) Employment HistoryIf you have a resume, you may attach; however, completion of this section is required. Attach additional sheets if necessary. Starting with your present or most recent job, account for all periods of time, unemployment and military service included. (All Applicants Must Account For The Last 10 Years). Employment HistoryCompany NameFrom (month/year)To (month/year)AddressStarting job titleEnding job titleSupervisor's name and job titleType of businessPay startingPay endingReason for leavingPhone No.May we contact this employer?Job titles and duties performed in this position Please click the plus sign to add more rows.Military ServiceComplete this section if you served in the U.S. Armed ForcesBranch of Service Active Period of Duty MM slash DD slash YYYY FromActive Period of Duty MM slash DD slash YYYY ToDate of Final Discharge MM slash DD slash YYYY Current rank or rank at discharge Non-member Active Reserve Inactive Reserve National Guard Describe your duties and any special trainingGeneral InformationHave you ever pled guilty or been convicted of a criminal offense? Yes No (Conviction will not necessarily disqualify applicant from employment)If yes, please list dates, offenses, and places: Please indicate other information you think would be helpful to us in considering you for employment, such as special interests, activities, accomplishments, etc. (You may exclude all information indicative of age, sex, race, religion, color, national origin and disability.)Personal References: Do not list relatives or employers*NameAddressArea Code & Phone No.Occupation Please click the plus sign to add more rows. Applicant's Agreement and CertificationAll material received through the application process becomes the property of Brescia University and will not be returned. I understand and agree that any relevant and material misrepresentation made on this application (including resume) will justify immediate dismissal if hired. I authorize Brescia University and/or their licensed agents to make any and all necessary and appropriate investigations to verify information in this application, including a check of criminal records, educational credentials, and work experience. I understand that references are obtained in confidence, and I waive my rights to view any reference(s) received by Brescia University and release providers of information from all liability in responding to inquiries about me. I understand that if hired by the employer, my employment may be terminated at any time by me or the employer with or without cause. I understand that no representative of the University has any authority to enter into an agreement for employment for any specified period of time. I understand that this application is for only the position indicated in the heading and that Brescia University will not consider this application as active for any other vacancy. I further understand that in no event will this application be considered an active application after 60 days from the date of my signature. By signing below, I certify that I have read, fully understand and accept all the statements above. Consent I agree to the applicant's agreement and certificationName First Last ResumeMax. file size: 50 MB.