Eastern Iowa Community College District 306 West River Drive, Davenport, Iowa 52801-1211, (563) 336-3342  Clinton Community College     Mail to: Ron Serpliss     Dean of the College     1000 Lincoln Boulevard     Clinton, IA 52732    Muscatine Community College     Mail to: Jeff Armstrong     Dean of the College     152 Colorado St.     Muscatine, IA 52761    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 Heath 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):   Date:_______________  Description of Experience:______________________________________________________   (Employer, if applicable):____________________________________________________________________________   Date:_______________  Description of Experience:______________________________________________________   (Employer, if applicable):____________________________________________________________________________   Teaching and/or Training Experience:   Date:_______________  Number of Years:_______  Institution:_____________________________________________   Courses Taught:____________________________________________________________________________________   Date:_______________  Number of Years:_______  Institution:_____________________________________________   Courses Taught:____________________________________________________________________________________   Work Availability:   Days of Week:  Any Day Monday-Saturday___  Mon.___  Tues.___  Wed.___  Thur.___  Fri.___  Sat.___   Time of Day:  Morning___  Afternoon___  Evening___   Are you willing to teach On-Line classes via the Internet?  ___(yes)  ___(no)   Fluency/Special Skills:   Language Fluency:  Are you fluent in English?_______  Are you fluent in any other language?______________________   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.   Name:__________________________________________  Position:__________________________________________    Name of Organization:__________________________________________  Telephone #:_________________________    Address:___________________________________________________________________________________________     Name:__________________________________________  Position:__________________________________________    Name of Organization:__________________________________________  Telephone #:_________________________    Address:___________________________________________________________________________________________     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:___________________