Fillable Staff/administrator Application Form (Page 2 of 2) in pdf

EMPLOYMENT HISTORY: You may attach a resume or other written narrative that provides the information requested below. Starting

from the most recent position, please list all experience, that is relevant to the position for you are applying. You may include military

and volunteer experience. You may also choose to attach additional copies of this section of the form.

Name of Employer: _________________________________________________ Supervisor Name:__________________________________

Address: _________________________________________________________ Supervisor Telephone#: _____________________________

Number

Street

City

State

Zip

Dates Employed:

Salary:

Starting

Ending

Starting

Ending

Full Description of Duties:

Reason for leaving:

Name of Employer: _________________________________________________ Supervisor Name:__________________________________

Address: _________________________________________________________ Supervisor Telephone#: _____________________________

Number

Street

City

State

Zip

Dates Employed:

Salary:

Starting

Ending

Starting

Ending

Full Description of Duties:

Reason for leaving:

Name of Employer: _________________________________________________ Supervisor Name:__________________________________

Address: _________________________________________________________ Supervisor Telephone#: _____________________________

Number

Street

City

State

Zip

Dates Employed:

Salary:

Starting

Ending

Starting

Ending

Full Description of Duties:

Reason for leaving:

REFERENCES: List references who can comment upon your EDUCATION AND/OR JOB RELATED experience.

Do not list relatives and/or friends.

Name

Relationship

Phone 8 - 5 (

_-_

Name

Relationship

Phone 8 - 5 (

_-_

Name

Relationship

Phone 8 - 5 (

_-_

THIS APPLICATION IS NOT COMPLETE UNTIL THE FOLLOWING IS READ AND SIGNED

I certify that all information provided at the time of application is true and correct. If EMPLOYED, I understand that any falsification of my application

materials may be cause for immediate termination. I further understand that I must complete the pre-employment processing which may include: signing a Loyalty

Oath, completing a Medical Examination/Fingerprinting/Background Check (as appropriate) and attending the New Employee Orientation.

The Immigration Reform and Control Act of 1986 requires you to provide proof of identity, documentation of your citizenship or resident status authorizing

you to be legally employed. This federal regulation requires you to sign a certification that information and documentation provided are true and correct, in active status

and you attest under penalty of perjury on Form I-9, Employment Verification Eligibility. I certify that if I am hired by San Francisco State

University, I shall produce the required documentation on or before my hire date that attests to my identity and legal authorization to work. I understand that it will be my

responsibility to ensure that the documentation I present at the time of the job offer will be kept in active status and that I shall apply to the appropriate authority for an

extension, in the event my documentation expires while I am employed.

San Francisco State University's annual security report includes statistics for the previous three years concerning reported crimes that occurred on campus, in

certain off-campus buildings or property owned or controlled by SFSU and on public property within, or immediately adjacent to an accessible from the campus. The report

also includes institutional policies concerning campus security, alcohol/drug use, and crime prevention, reporting of crimes, sexual

assault and other matters. You may obtain a copy of this report by contacting the Department of Public Safety or by accessing the following web sites:

~or~

PRINT NAME:

SIGNATURE:

Date:

SAN FRANCISCO STATE UNIVERSITY IS AN EQUAL OPPORTUNITY-TITLE IX EMPLOYER

Staff/Administrator Application- Page 2 of 2

June 2014