Eastern Iowa Community College District
306 West River Drive, Davenport, Iowa 52801-1211, (563) 336-3342
Dot image Clinton Community College
    Mail to: Ron Serpliss
    Dean of the College
    1000 Lincoln Boulevard
    Clinton, IA 52732
  Dot image Muscatine Community College
    Mail to: Gail Spies
    Dean of the College
    152 Colorado St.
    Muscatine, IA 52761
  Dot image Scott Community College
    Mail to: Reg Shoesmith
    Faculty Recruiter
    500 Belmont Road
    Bettendorf, IA 52722
Employment Application, Part-Time (Adjunct) Faculty
Date:___________________
Name: _________________________________________________________
 
Last First Middle
Address:_____________________________________________________________________________________________
Phone:  Home:__________________________  Cell:__________________________  Work:__________________________ 
E-mail Address:_________________________________________________
Position Desired:
  Site:  ___Clinton Community College,    ___Muscatine Community College,    ___Scott Community College
  Teaching Area:
    Arts & Sciences (College Transfer-Must have MA or MS degree in area teaching or a MA/MS degree and
18 graduate hours of credit in the area you wish to teach.)
                Area(s) you want to teach: (Examples of teaching areas: Business, Biology, English, etc.)
                _________________________________________________________
 
    Applied Technologies (Career/Technical Education degrees, Associates of Applied Science programs 2
years in length, but also some Certificate and Diploma Programs) Relevant Business/Industry experience
is critical. Some programs require a Graduate degree, some, a four-year degree, while other areas require
Journeyman/apprenticeship or equivalent certification. Teaching requirements vary from department to
department. Examples of teaching areas: Allied Health Services, Business, Child Development & Sign
Language Interpreter Training, Culinary Arts and Hospitality Services, Industrial & Design &
Environmental, Health, Safety & Environmental, Manufacturing, Microcomputer Information, Nursing,
and Transportation).
                Area(s) you want to teach:
                _________________________________________________________
Education/Training:
High School:______________________________________________________________  Year Graduated:_______________
 
College/University, Technical School:_________________________________________________________________________
   Degree/Certification:_____________________  Major:_____________________  Year Graduated:_______________
 
College/University, Technical School:_________________________________________________________________________
   Degree/Certification:_____________________  Major:_____________________  Year Graduated:_______________
 
College/University, Technical School:_________________________________________________________________________
   Degree/Certification:_____________________  Major:_____________________  Year Graduated:_______________
 
Certifications/Licensures: List any special certifications by professional governing bodies, or governmental agencies
that are related to your application area. _________________________________________________________________
 
The Eastern Iowa Community College District endorses the principle of equal educational opportunities for all people regardless of race, color, creed,
marital status, national origin, sex, sexual orientation, religion, ancestry, age, or non-job related handicap or disability in the educational programs or
activities it operates. Persons having inquiries concerning the district's accommodation for or compliance with Title VI, Title IX, Section 504, the
Americans with Disabilities Act and the Age Discrimination Act may contact: Affirmative Action Officer, 306 W. River Drive, Davenport, IA 52801-1221
or call *(563) 336-3300.
 
 
 
Work Experience and/or Relevant Volunteer Experience (this may be detailed on your resume):
Dot image  Date:_______________  Description of Experience:______________________________________________________
 (Employer, if applicable):____________________________________________________________________________
Dot image  Date:_______________  Description of Experience:______________________________________________________
 (Employer, if applicable):____________________________________________________________________________
 
Teaching and/or Training Experience:
Dot image  Date:_______________  Number of Years:_______  Institution:_____________________________________________
 Courses Taught:____________________________________________________________________________________
Dot image  Date:_______________  Number of Years:_______  Institution:_____________________________________________
 Courses Taught:____________________________________________________________________________________
 
Work Availability:
Dot image  Days of Week:  Any Day Monday-Saturday___  Mon.___  Tues.___  Wed.___  Thur.___  Fri.___  Sat.___
Dot image 
Time of Day:  Morning___  Afternoon___  Evening___
Dot image 
Are you willing to teach On-Line classes via the Internet?  ___(yes)  ___(no)
 
Fluency/Special Skills:
Dot image  Language Fluency:  Are you fluent in English?_______  Are you fluent in any other language?______________________
Dot image  Special Skills you possess related to your application_______________________________________________________
 
 
Resume: Please attach a resume to this application.
(Note: To complete the hiring process, official transcripts must be on file in the applicable Division Office.
If you are invited for an interview, please bring an unofficial copy of your transcripts with you.)
 
References: Please list 3 references and contact information.
Dot image  Name:__________________________________________  Position:__________________________________________
   Name of Organization:__________________________________________  Telephone #:_________________________
  Address:___________________________________________________________________________________________
 
Dot image  Name:__________________________________________  Position:__________________________________________
   Name of Organization:__________________________________________  Telephone #:_________________________
  Address:___________________________________________________________________________________________
 
Dot image  Name:__________________________________________  Position:__________________________________________
   Name of Organization:__________________________________________  Telephone #:_________________________
  Address:___________________________________________________________________________________________
 
I certify that the information given herein is true and complete to the best of my knowledge.
 
Signature:_________________________________________________________________  Date:___________________