East Arkansas Community College1700 Newcastle Road Forrest City, AR 72335 870-633-4480
Position(s) for which you are applying:
if selected "Other" what position are you applying for?
Will you accept any type of employment?
If no, check which type(s) of employment you will accept:
Teaching availability for adjunct faculty position(s):
Have you ever filed an application for employment at East Arkansas Community College?
If yes, what was your name at that time?
Have you ever been employed by Arkansas State Government?
List professional license(s) relevant to position(s) for which you are applying. Give type of license, license number, date of expiration, and state.
May we contact your (current) employer?
May we contact your (former) employer(s)?
Have you been convicted of a felony, misdemeanor, or deferred adjudication?
If Yes, list offense and date of convictions, (Conviction will not necessarily disqualify applicant from employment). Offense and date:
Did you receive a high school diploma or GED equivalency?
List highest grade completed if none of the above applies:
List below post-secondary schools, colleges, universities, trade/vocational, or others attended. Resumes may be submitted in addition to a completed signed employment application but will NOT be considered as a substitute.
1. School Information:
Name and Location:
Dates Attended From:
Dates Attended To:
2. School Information:
3. School Information:
List all prior work experience, including military service, beginning with your most recent employment. (Include all work experience even if you do not believe that experience to be related to the position or positions for which you are applying.) You may include volunteer or unpaid work as part of your history; however, you should include the number of hours per week which you performed these duties. If you do not have enough space to list all your work experience, use a separate sheet for continuation. Resumes may be submitted in addition to a completed signed employment application but will NOT be considered as a substitute.
WORK HISTORY 1:
Current or most recent employer:
Complete mailing address:
Type of Business:
Name under which employed:
Job Duties (be specific):
Employment Date From:
Employment Date To:
Average hours worked per week:
Rate of Pay:
WORK HISTORY 2:
WORK HISTORY 3:
WORK HISTORY 4:
WORK HISTORY 5:
Typing Speed, if applicable to position (corrected words per minute):
List the business machines, computers and software applications you can operate:
Please list three (3) persons not related to you who have knowledge of your work qualifications and can serve as a professional reference.
Do you have any relatives employed by East Arkansas Community College?
If yes, complete the remainder of this section. (This question is being asked for the sole purpose of ensuring compliance with any applicable law or policy concerning nepotism.)
Name: Relationship: EACC Position:
In case of an emergency, please contact:
State of Arkansas/Department of Finance and Administration Employee Disclosure/Certification and Employment of Family Members Form
I understand that to be eligible for employment with the State of Arkansas, I must be in compliance with Governor’s Executive Order 98-04, Governor’s Policy Directive No. 8 and Arkansas Code Annotated (ACA) §21-8-304, which state, in part, that, while employed as a state employee, I cannot enter into any Professional Services Contract or Consultant Service Contract with any state agency unless I am providing Nursing Services and contracting with the Department of Health & Human Services. I also understand that as an employee of the State of Arkansas I am restricted from supervising or being supervised by a relative under ACA §25-16-1002. If I am hired and it can be proven I falsely disclosed or failed to disclose information I could be subject to criminal, civil and/or administrative remedies. I assert that I have answered the above questions to the best of my knowledge.
* Former: is defined as within the last 24 months.
**Constitutional Officer: Governor, Lt. Governor, Secretary of State, Attorney General, Auditor, Treasurer, Land Commissioner.
†Relative includes: husband, wife, mother, father, stepmother, stepfather, mother-in-law, father-in-law, sister, brother, stepsister, stepbrother, half-sister, half-brother, sister-in-law, brother-in-law, daughter, son, stepdaughter, stepson, daughter-in-law, son-in-law, aunt, uncle, first cousin, niece or nephew.
‡Public Official: includes constitutional officers; members of the Arkansas General Assembly; the executive head of any agency, department, board, commission, institution, bureau, or council of the state.
Are you a current or former* state employee?
Are you a current Constitutional Officer** or Arkansas General Assembly member?
Are you the spouse of a current Constitutional Officer** or Arkansas General Assembly member?
If “Yes,” give spouse’s name & office:
If “Yes,” is your expected salary above the pay grade 13, level IV?
Are you a former* member or the spouse of a former member of the Arkansas General Assembly?
If “Yes,” within the 24 months prior to your leaving office or your spouse leaving office, was the position for which you are being considered created by legislative action, or if the maximum salary level increased by more than 15%, was this authorized by legislative action?
Are you a relative† of the Public Official‡ in charge of the agency in which you are applying?
Are you a relative† (other than the spouse) of a Constitutional Officer or an Arkansas General Assembly member or are you a relative† of a state employee, state board or commission member?
If you checked “Yes” above, does this relative† work within the state agency in which you are applying?
If “Yes”, is the position for which you are applying in the direct line of supervision of your relative or will the position be a supervisory employee of the relative.
This section is designed to collect information which will be used in the completion of various state and federal reports and will not be used in the processing of, or remain part of, your application. The completion of this section is voluntary.
Social Security Number:
Date of Birth:
Check one of the six (6) listed which you consider yourself to be:
If you believe you may be eligible for veteran’s preference consideration, complete this section. The Arkansas Veterans Preference Act states specific requirements which must be met in order to be eligible for veterans preference. Under certain conditions spouses, widows, or widowers of qualified veterans may also be eligible for veterans preference. For consideration of veterans preference, proof such as a DD-214, current letter from the Veterans Administration, or other official documentation may be required.
Have you served on active duty in the United States military, excluding Active Duty for Training (AcDuTra) and Reserve Military Annual Training (AT)?
Branch of Service:
Date of Entry:
Date of Discharge:
Type of discharge:
How did you learn of this job opening?
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
(You are only allowed to attach one document per button.)
Please upload your documents here: