City Park Campus

    West Bank Campus

    Community Campus

    School of Nursing

    Slidell Site

    Covington Site

    Sidney Collier

     

    APPLICATION FOR EMPLOYMENT
    STATE OF LOUISIANA

    501 CITY PARK AVENUE
    NEW ORLEANS, LOUISIANA 70119-4399
    AN EQUAL OPPORTUNITY EMPLOYER
     
         		  
             
    Last Name First Name
    Middle Name
    		 
    Soc. Sec. No.
             
    Area of Concentration ______________________________________________________________   Date  
             
    Type of Employment Desired: Full Time Part Time Day Night   Phone    
     
    Present Home Address        
      Street City State Zip
             
    Place of Birth  
    Are you 18 of older?
    Yes
    		No
             
    U.S. Citizen Yes No

     
    Please attach:
    		I-9 Forms and Documents
             
           
           
           
    Have you ever been employed by Delgado? If so, in what capacity?   Date      
     
    Do you have any relatives employed at Delgado? ___Yes ___No
          		 
    If so, please provide     		 
    Name________________     		 
    Relationship_____________      		  
    EDUCATION
    Institution Attended
    Location
    Date
    Degree
    Major
                       
                       
                       
    EMPLOYMENT HISTORY
     
    List all employment. Start with present or most recent position. Include all jobs since age 18 (or last 4 jobs, whichever is less).
    Employer (Present or Most Recent)
           		 Street Address, City, State, Zip
       
    Your Job Title
           		 Supervisor
       
    Description of your duties:
           		 From (Mo./Yr.)
           		 To (Mo./Yr.)
       
        Base Pay Starting
    Per yr
    Final
    Per yr  
     

              		Reason for Leaving
           		  
     

              		 
         
    May we contact you at your
    present place of employment? Yes No     		May we contact your present
    Employer for references? Yes No     		If yes, please enter:
    Area Code/Telephone No. Ext      

      
    Employer
           		 Street Address, City, State, Zip
        
    Your Job Title
           		 Supervisor
       
    Description of your duties:
     
           		 From (Mo./Yr.)
           		 To (Mo./Yr.)
     
     
              		Base Pay Starting
    $      Per   
    Final
    $      Per   
     
              		Reason for Leaving
           		  
     
              		 
         
    May we contact you at your
    present place of employment? Yes No     		May we contact your present
    Employer for references? Yes No     		If yes, please enter:
    Area Code/Telephone No.       Ext      

     
    Number of years related professional work experience _     ____
     
    Delgado Community College adheres to a policy of non-discrimination in employment based on race, color, creed, sex, or national origin.
    The information with regard to race/ethnicity is voluntary; this information will be used in a nondiscriminatory manner, consistent with applicable civil rights laws. Provision of the information requested below is optional and issued by the College for research or federal/state law reporting purposes. The information will not be used in any employment decision; you are NOT legally obligated to provide this information.
     
    Race/Ethnic Group:
    White Black American Indian
    Asian/Pacific Islander     Hispanic Eskimo/Aleutian     		 
    Are you a member of a reserve component of the armed forces?
    Yes No
     
    Sex:
    Male Female     		 
    Date of Birth:
         

    		Veteran Status: Non-Veteran Vietnam Era Veteran
    Disabled Vietnam Era Veteran     Veteran – other
    Disabled Veteran – other

     
    REFERENCES: Other than Relatives
    Names
    Complete Addresses (Please be specific)
     
           		      
         
          		     
         
          		     
    SUPPLEMENTARY DATA:
    Awards, Honors, Travel, Affiliations and Memberships, Publications, Research, Exhibits, Major Performances,
    Other areas of competence, Community and Professional Activities, etc.
         
         
         
         
         
    I understand that the Immigration Reform and Control Act of Novembe r 6, 1986 requires me to prove the legality of my residency or citizenship. I also understand I must have official transcript of all college credits sent directly from the institution or institutions to the Department of Human Resources.
    I am aware that any falsification of information or failure to provide essential information will be cause for disqualification or dismissal.
    Signature___________________________________________ Date ______________________________
    FOR INSTITUTIONAL USE ONLY!
     
     
     
     
     
     
     
     
     
      

     

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