Internal Transfer / Promotion Application Form

Mississippi Valley State University

An

Equal Opportunity Employer and Educator

DEPARTMENT OF HUMAN RESOURCES

MVSU 7260 – 14000 HWY 82 WEST - ITTA BENA, MS 38941

______________________

INTERNAL TRANSFER / PROMOTION APPLICATION

If you are an individual with a disability and need reasonable accommodation to participate in the hiring process, please contact the Human Resources Department at 662-254-3531

PLEASE NOTE: APPLICANTS MUST COMPLETE THE FOLLOWING QUESTIONS COMPLETELY, AND ATTACH A RESUME

Please Type or Print Neatly.

APPLICATION DATE: _________________________________________________

POSITION APPLYING FOR: ___________________________________________________

DEPARTMENT: ______________________________________________________

PERSONAL INFORMATION

Last Name: ___________________________________

First Name: ____________________________________

Middle Name:_____________________________________

Home Phone: (

) ____________________________

Campus Phone: (

) __________________________

Email Address: ___________________________________

MVSU EMPLOYMENT INFORMATION

Current

Current Position: _______________________________

Department: ____________________________________ Start Date: _____/_______/_____ Pay: _______________

Previous Position: _______________________________ Department: ____________________________________ Dates: From _____/_______/_____ to _____/______/_____

Home Phone: (

) ____________________________

Campus Phone: (

) __________________________

Email Address: ___________________________________

EDUCATIONAL INFORMATION

Highest Level of Education Completed:

High School Diploma

GED

Vocational/Technical Certification

Associate Degree

Bachelors Degree

Masters Degree

Doctoral Degree

Major Field of Study: _____________________________

Date Degree Confirmed: ______/______/________

Are you currently registered to attend classes at MVSU?

Yes

No

If yes, number of hours enrolled? ________

Days/Times __________________

Are you currently registered to attend classes at another Institution?

Yes

No

If yes, number of hours enrolled? ________

Days/Times __________________

Have you obtained a professional certification or a degree since your original hire date?

Yes

No

Date Degree Confirmed: ______/______/________

If so, please indicate degree and/ or certification._________________________________________________________________________________________________________

CONDITIONS OF CONTINUED EMPLOYMENT

In submitting this application, I understand that false statements will disqualify me from employment or cause my subsequent dismissal. I also understand that an extended background

investigation may be required for certain positions. If selected, I understand that it is my responsibility to arrange an agreeable start date between my current and new supervisor.

______________________________________________________________

___________________________________________

_____________________________

Signature of Applicant

Employee ID#

Date

REQUIRED SIGNATURES

__________________________________/_____/_____

Director of Human Resources

Date

Revised 9/2014

Department of Human Resources

INTRANSFORM