EICC Employment Application

Personal Information

Name

Title
*First Name
Middle Initial
*Last Name
Suffix

*Are you a current EICC employee?

Yes, I am an internal candidate

If yes, please list position and location

No, I am applying as an external candidate

Current Address

*Number & Street
Apt. Number
*City
*State
*Zip/Postal Code
*Country
*Phone
*Email

Position Desired

*Please enter the positions for which you would like to be considered.

Describe the skills or attributes you believe are necessary to be an outstanding candidate for the position applied for.

Current Employment Status & Experience

Current or Most Recent Position Held

*Company:
*Position:

Employer Contact Information

Street:
City:
*State
Zip:
*Phone:

Employment Details

*Date From:
*Date To:
Full or Part Time: Full Part Sub
*Reason for leaving:
*May we contact your current employer: Yes No

Add Another Previous Position Held

Company:
Position:

Employer Contact Information

Street:
City:
State:
Zip:
Phone:

Employment Details

Date From:
Date To:
Full or Part Time: Full Part Sub
Reason for leaving:

Add Another Previous Position Held

Company:
Position:

Employer Contact Information

Street:
City:
State:
Zip:
Phone:

Employment Details

Date From:
Date To:
Full or Part Time: Full Part Sub
Reason for leaving:

Add Another Previous Position Held

Company:
Position:

Employer Contact Information

Street:
City:
State:
Zip:
Phone:

Employment Details

Date From:
Date To:
Full or Part Time: Full Part Sub
Reason for leaving:

Add Another Previous Position Held

Company:
Position:

Employer Contact Information

Street:
City:
State:
Zip:
Phone:

Employment Details

Date From:
Date To:
Full or Part Time: Full Part Sub
Reason for leaving:

Education

Please tell us about your educational background beginning with the most recent. For each institution, list the college semester hours you received in your major and minor.

*What is your highest education level completed?

Colleges, Universities and Technical Schools Attended:

Name and Location
Start Date and End Date: End Date:
Major area of study
Degree
Date Conferred or Expected

Add another College, University or Technical School Attended

Name and Location
Start Date and End Date: End Date:
Major area of study
Degree
Date Conferred or Expected

Add another College, University or Technical School Attended

Name and Location
Start Date and End Date: End Date:
Major area of study
Degree
Date Conferred or Expected

High School

High School Attended (Name, City and State)
High School Status

For Instructor Candidates

Number of graduate hours beyond your highest degree
Graduate program area of study
List honors, awards or distinctions you have earned:

References

*Name:
School/Org:
Current Position:
Relationship to Candidate:
Years Known:
*Contact Phone:
Email:

Add Another Reference

Name:
School/Org:
Current Position:
Relationship to Candidate:
Years Known:
Contact Phone:
Email:

Add Another Reference

Name:
School/Org:
Current Position:
Relationship to Candidate:
Years Known:
Contact Phone:
Email:

Required Information

Have you ever been asked to resign from a position or been dismissed?

Yes No
If yes, please explain:

*Have you ever been previously employed by Eastern Iowa Community Colleges?

Yes No
*If yes, please explain:

Are you able to speak more than one language?

Yes No
If yes, please please list languages other than English:

List any additional information which will help in determining your professional qualifications for a position with Eastern Iowa Community Colleges.

*Are you currently under contract with any other Iowa Public Education Institution?

Yes No
If yes, what district and when does your contract expire?
*Have you successfully completed an official probationary period in a public school district?

Yes No N/A Non-Faculty Position
If yes, what district?
If yes, what was the length of the probationary period?

Referral Source

How did you hear about employment with us? Check all that apply.

District Employee

District Website

Newspaper/Print Media

Social Media

Job Boards

Other
Other:

Background Inquiry

To ensure that individuals who join EICCD are well qualified and have a strong potential to be productive and successful employees, it is EICCD's policy to investigate the backgrounds and employment references of applicants.

In addition, EICCD may conduct background investigations when employees are being considered for promotions or transfers, or in furtherance of an internal investigation of alleged misconduct. Background investigations will be conducted at EICCD's discretion and in accordance with federal and state law. EICCD relies on the accuracy of information contained in employment applications and resumes, as well as the accuracy of other data presented throughout the hiring process and during employment. Any misrepresentations, falsifications, or material omissions in any of this information or these data may result in an applicant being excluded from further consideration for employment or, if an individual has already been hired, termination of employment.

Information obtained from a background investigation will be considered for employment purposes as permitted by federal and state law and in accordance with EICCD's Equal Employment Opportunity Policy. Information will be reviewed to determined:

Whether false statements or material omissions were made by an individual on an application for employment or during an interview:
Whether an applicant or employee, based on the job duties of the position in question, poses a threat to security and/or employee safety in the workplace; and
The likelihood of an applicant or employee being successful and productive on the job.

Background investigations will be conducted as follows:

Applicants for Employment
All applicants who are offered employment with EICCD will be subject to a background investigation. Offers of employment are contingent on the successful completion of a background investigation conducted in accordance with EICCD policy and state law.
Current Employees
Current employees who are being considered for promotion or transfer may be subject to a background investigation. Background investigations may also be conducted as part of an internal investigation of alleged employee misconduct.

Every offer of employment with EICCD will be made contingent on a background investigation. The nature and extent of the investigation will depend on the job duties of the position for which an offer is made. EICCD will determine an applicant's or employee's suitability for the position using, in part, the following factors: relevance of the crime to the position sought, nature of the work to be performed, time since any conviction, age of the candidate at the time of the offense, seriousness and specific circumstances of the offense, the number of offenses, any relevant evidence of rehabilitation or lack thereof, and any other relevant information, including information submitted by the candidate.

* I have read this section entitled "Background Inquiry"

Equal Opportunity Employer

It is the policy of Eastern Iowa Community Colleges not to discriminate on the basis of race, color, national origin, sex, disability, age (employment), sexual orientation, gender identity, creed, religion, and actual or potential parental, family or marital status in its programs, activities, or employment practices as required by the Iowa Code §§ 216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C. §§ 1681 - 1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).

If you have questions or complaints related to compliance with this policy, please contact Debora J. Sullivan, Equity Coordinator, 306 W. River Dr., Davenport, Iowa 52801, (563)336-3487, djsullivan@eicc.edu, or the Director of the Office for Civil Rights, U.S. Department of Education, Citigroup Center, 500 W. Madison, Suite 1475, Chicago, IL 60661, phone number 312/730-1560, fax 312/730-1576.

* I have read this section entitled "Equal Opportunity Employer"

Applicant's Acknowledgement and Agreement

I hereby certify that the above information, to the best of my knowledge, is true, accurate, and complete. Any misrepresentations or willful omissions of fact shall be considered sufficient cause for disqualification of this application or termination of employment.

I authorize verfication of any of this information. I authorize all current (unless so noted) and former employers, schools, and individuals to release any information concerning my background.

I understand that this application is not a contract of employment. I also understand that, if hired, regardless of any oral representation to the contray, the employment relationship is terminiable-at-will.

I understand that the offer of employment is conditioned on the results of the background check. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity. Failure to submit such proof will result in denial of employment.

*I, * Full Name, agree to all the terms above.

Yes No
Upload resume

	Yes, I am an internal candidate If yes, please list position and location
	No, I am applying as an external candidate

	District Employee
	District Website
	Newspaper/Print Media
	Social Media
	Job Boards
	Other