Employment Application Form

Indiana University is an Equal Opportunity/Affirmative Action Employer.

PRINTABLE FORM

PERSONAL INFORMATION

*Are you over 18 years of age? yes    no

If required for the position, do you hold a valid driver's license? yes    no

*Are you legally authorized to work in the United States? yes    no

Are you a current Indiana University employee? yes    no

If yes, date started, position, and location:

*Have you ever been employed by Indiana University in the past? yes    no

If yes, your name (if different), date started and left, position, and location:

*Have you ever been convicted of a crime other than a minor traffic violation? yes    no
Convicted means you were declared guilty by a judge or you pleaded guilty in court. A conviction may have even taken place if you did not pay a fine or spend time in jail or in prison. A conviction could have been for either a misdemeanor or a felony. A minor traffic violation is an infraction for which you would be ticketed. Driving while under the influence, driving on a suspended license, reckless driving, leaving the scene of an accident and vehicular homicide are not minor traffic violations. A criminal history investigation is done on each new employee, and employment with the University is conditional, subject to the findings of a criminal history investigation. Answering yes to this question does not automatically disqualify you for employment; however, information obtained from the investigation will be used in the employment review process.

If yes, it is mandatory that you complete this section. List each offense: date, charge, city, state and dispensation

 

*EDUCATION

EMPLOYMENT INFORMATION

What type of work will you accept?

*Work History: List your work history for at least the past seven years. Begin with the most recent position.

#1

From: To:   

Name of Firm:

Address:   Supervisor:

Duties Involved:

Salary:   Reason for Leaving:

#2

From: To:   

Name of Firm:

Address:   Supervisor:

Duties Involved:

Salary:   Reason for Leaving:

#3

From: To:   

Name of Firm:

Address:   Supervisor:

Duties Involved:

Salary:   Reason for Leaving:

#4

From: To:   

Name of Firm:

Address:   Supervisor:

Duties Involved:

Salary:   Reason for Leaving:

#5

From: To:   

Name of Firm:

Address:   Supervisor:

Duties Involved:

Salary:   Reason for Leaving:

Special Skills

Special skills/foreign languages/certifications/licenses:

Special equipment/computer hardware or software/industrial machinery/video or teleconferencing:

APPLICANT STATEMENT & SIGNATURE

Please read and sign the following statement:

All offers of employment, oral and written, shall include the following statement: "This offer is contingent on the university's verification of credentials and other information required by state law and IU policies, including the completion of a criminal history check."

I certify that all information provided in all my application material is true. I understand that any false statement made herein is sufficient reason for rejection of this application or termination of subsequent employment regardless of date of discovery. I authorize the University to investigate all statements made in my application material for employment. I authorize such educational institutions and employers and others (and their agents or employees) to respond to questions concerning information given in this application material and I further release from liability such former employers, institutions, or persons providing such information to the University.

Indiana University complies with the Drug-Free Workplace Act of 1988 and the Drug-Free Schools and Communities Act Amendments of 1989. The unlawful manufacture, sale, distribution, dispensation, possession or use of a controlled substance (usually referred to as illegal drugs listed under the federal Controlled Substances Act) and alcohol is prohibited on University property, or in the course of a University activity, and may result in employee discipline up to and including termination of employment.

I agree that the University may require my participation in and contribution to retirement programs while employed. I also understand that direct deposit of my paycheck to my personal checking or savings account is a condition of employment. I understand that no offer of benefits such as a pension plan, insurance, vacation or salary rate is final until cleared by Human Resources, and fully approved by appropriate University officials.

*Signature:_________________________________________________   *Date: ___________________________

By signing you signify that all the information you have provided is true and that you have read and understand the Applicant's Statement.

All questions and statements must be answered in full or your application will not be processed.

PRINT and mail this form to the department to which you are applying.