Supervisor High School
Resume:
WALTERSSTATE
THE GREAT SMOKY MOUNTAINS COMMUNITY COLLEGE
A Tennessee Board of Regents College
Morristown, Tennessee 37813-6899
An Equal Opportunity/Affirmative Action Employer
PROFESSIONAL STAFF AND FACULTY APPLICATION
(Please type or print plainly and return to the Office of Distance Education)
Date:
Position(s) for which you are applying:
1.
2.
3.
1. Name
last first middle maiden (if shown on school or
employment records)
2. Mailing Address
street city state zip code
Telephone: Home: Other:
E-mail address: __________________________________
3. Availability Recap:
Will you accept temporary employment? [ ] Yes [ ] No Part-time? [ ] Yes [ ] No Full-time? [ ] Yes [ ] No
Will you teach evening or night classes? [ ] Yes [ ] No Will you teach off-campus classes? [ ] Yes [ ] No
What is the minimum salary you will accept? $ Date available?
ANSWER ALL SECTIONS CAREFULLY AND COMPLETELY. DO NOT USE “SEE RESUME OR OTHER DOCUMENTS”.
ALL STATEMENTS MADE IN THIS APPLICATION MAY BE VERIFIED.
4. Educational Background:
Year Attended
Last high school attended ____________________________________________________
Address
Dates Attended Field of Study or Area of Type of degree
Names and Addresses of Colleges or Concentration Obtained & Date Total Semester
Universities Attended Hrs.
From To Major Minor
5. Experience: Use a separate block for each position. Start with your present position and work back, explaining
clearly the principal tasks which you performed in each position, accounting for all periods of employment. Use
additional pages if further space is needed. If you have never been employed or are now unemployed, indicate
that fact in the space provided below:
Do you have objections to your present employer being contacted prior to the time of interview?
[ ] Yes [ ] No [ ] NA
Your Title Name and Title Immediate Supervisor
Firm Name Address/Phone
Length of Employment Total Annual Salary 9 Months/ Reason for Leaving
12 Months
From To Years Months
Duties
Your Title Name and Title Immediate Supervisor
Firm Name Address/Phone
Length of Employment Total Annual Salary 9 Months/ Reason for Leaving
12 Months
From To Years Months
Duties
Your Title Name and Title Immediate Supervisor
Firm Name Address/Phone
Length of Employment Total Annual Salary 9 Months/ Reason for Leaving
12 Months
From To Years Months
Duties
Your Title Name and Title Immediate Supervisor
Firm Name Address/Phone
Length of Employment Total Annual Salary 9 Months/ Reason for Leaving
12 Months
From To Years Months
Duties
Your Title Name and Title Immediate Supervisor
Firm Name Address/Phone
Length of Employment Total Annual Salary 9 Months/ Reason for Leaving
12 Months
From To Years Months
Duties
6. HANDWRITTEN Autobiographical Statement (Required of ALL faculty, administrative and professional staff positions).
Write a statement concerning your personal background including some noteworthy experience you have had or
interesting activity in which you have been engaged within the last five years. Attach additional pages if necessary.
7. Professional Publications ________________________________________________________________________
_________________________________________________________________________________________________________
8. Professional Associations:
______________________________________________________________________________________________________________________
9. Prior and current employment by the state of Tennessee: [ ] Yes [ ] No. If “Yes” please provide information below
From To
Department or Agency
Month Year Month Year
10. Relatives currently employed at Walters State Community College: [ ] None [ ] Yes (if “yes”, list name, position
and relationship:
11. Have you ever been dismissed from employment for cause? [ ] No [ ] Yes If “yes”, please explain:
12. Have you ever been convicted or pleaded guilty to a criminal charge? (An affirmative response will not
necessarily be a bar to employment. Factors such as age, elapsed time, seriousness, nature and rehabilitation
will be taken into account.
References: List below at least four references not related to you who have first hand knowledge of your character, personality,
scholarship, and qualifications
Name and Position Address Telephone
14. ATTACHMENTS: A resume may be attached but MAY NOT be used in lieu of application.
15. This application will not be considered complete until official transcripts covering college or university work have
been received by the Office of Academic Access. Unofficial copies of transcripts are acceptable for applicant
processing purposes.
RELEASE OF INFORMATION TO WALTERS STATE COMMUNITY COLLEGE
16. Certification of Application: I hereby certify that all information contained in this application is true, complete
and accurate to the best of my knowledge. I also authorize any necessary investigations and the release of
transcripts and other personal information relative to my employment. Documents obtained become subject to
the Tennessee Public Records Act, T.C.A. 10-7-101, et. seq. I understand that misrepresentation of this
information may subject me to disqualification for compensation for any job or to termination of employment if
employed by any agency of Tennessee State Government.
Signature Date
Please address all correspondence concerning employment to: Office of Distance Education
Walters State Community College
500 S. Davy Crockett Parkway
Morristown, TN 37813-6899
Fax: 423-***-****
DISCRIMINATION IS PROHIBITED ON THE BASIS OF RACE, SEX, COLOR,
RELIGION, NATIONAL ORIGIN, AGE, DISABILITY, OR VETERAN STATUS.
The information requested below is to be given voluntarily; refusal to give it will not
subject you to any penalty.
Demographic Data:
Gender: [ ] Male [ ] Female
Date of Birth: ________ ____ _______
month day year
Race: [ ] 1. White Non-Hispanic
[ ] 2. Black Non-Hispanic
[ ] 3. Hispanic
[ ] 4. Asian or Pacific Islander
[ ] 5. American Indian
[ ] 6. Alaskan Native
*Citizenship: [] U.S.
[] Other
*Employment Eligibility:
Current federal law requires identification and eligibility verification prior to
employment.
Name:
last first middle maiden
Social Security Number: _________ - ______ - __________
Signature: Date:
WALTERS STATE COMMUNITY COLLEGE
Professional Staff and Faculty Application
Date:
To the registrar of:
Dear Registrar:
Please mail an official transcript of my record to:
Office of Distance Education
Walters State Community College
500 South Davy Crockett Parkway
Morristown, TN 37813-6899
as soon as possible.
My last period of attendance at your school was
My social security number is
(Last Name) (First Name) (Middle Name) (Maiden Name)
If there is a charge for this service, please bill me at the address indicated below:
(Street or Rural Route)
(City, State, and Zip Code)
(Signature)
WSCC 010**-*-*****-Rev. 10/95
Contact this candidate