Employment Application

• East Arkansas Community College is committed to providing equal opportunity through its employment practices, educational programs, admissions policies, scholarship and loan programs, and services it offers to the community. The College will make personnel decisions and offer programs that will foster educational opportunities without regard to race, color, national origin, age, gender, pregnancy status or disability of qualified handicapped persons.
  
  
• Applications, once filed, may be subject to disclosure as a public record under the Arkansas Freedom of Information Act.
  
  
• Applications filed do not create a contract of employment with East Arkansas Community College. If any individual is hired, employment is not for any definite period of time. Individuals hired will also be required to provide proof of eligibility to work in the United States pursuant to the Immigration Reform and Control Act of 1986.
  
  
• Qualified applicants with disabilities, as defined in the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, may request any needed accommodations to participate in the application process.

East Arkansas Community College
1700 Newcastle Road
Forrest City, AR 72335
870-633-4480

First Name:

Last Name:

Middle Name:

Mailing Address:

City:

State:

Zip Code:

County:

Phone Number:

Email Address:

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:

Major/Minor:

Dates Attended From:

Dates Attended To:

Degree:

Date Graduated:

2. School Information:

Name and Location:

Major/Minor:

Dates Attended From:

Dates Attended To:

Degree:

Date Graduated:

3. School Information:

Name and Location:

Major/Minor:

Dates Attended From:

Dates Attended To:

Degree:

Date Graduated:

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:

Business phone:

Complete mailing address:

City:

State:

Type of Business:

Supervisor's Name:

Name under which employed:

Job Title:

Job Duties (be specific):

Employment Date From:

WORK HISTORY 2:

Current or most recent employer:

Business phone:

Complete mailing address:

City:

State:

Type of Business:

Supervisor's Name:

Name under which employed:

Job Title:

Job Duties (be specific):

Employment Date From:

WORK HISTORY 3:

Current or most recent employer:

Business phone:

Complete mailing address:

City:

State:

Type of Business:

Supervisor's Name:

Name under which employed:

Job Title:

Job Duties (be specific):

Employment Date From:

WORK HISTORY 4:

Current or most recent employer:

Business phone:

Complete mailing address:

City:

State:

Type of Business:

Supervisor's Name:

Name under which employed:

Job Title:

Job Duties (be specific):

Employment Date From:

WORK HISTORY 5:

Current or most recent employer:

Business phone:

Complete mailing address:

City:

State:

Type of Business:

Supervisor's Name:

Name under which employed:

Job Title:

Job Duties (be specific):

Employment Date From:

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.

REFERENCE 1:

Name:

Occupation:

Business Address:

Telephone Number:

REFERENCE 2:

Name:

Occupation:

Business Address:

Telephone Number:

REFERENCE 3:

Name:

Occupation:

Business Address:

Telephone Number:

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:

EMERGENCY CONTACT

In case of an emergency, please contact:

Phone Number:

Relationship:

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,” give spouse’s name & office:

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?

If “Yes,” give spouse’s name & office:

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 “Yes,” give spouse’s name & office:

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.

Applicant’s Name:

Social Security Number:

Date of Birth:

Gender:

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?

1. Check over your answers to make sure that all questions have been completed properly. If the job you are applying for requires a college degree or certification, a copy of your transcript, certificate, or license will be required as a condition of employment.
2. I, the below signed individual, hereby declare that, to the best of my knowledge and my ability, the information on this application is true and factual.
3. I understand that if I am hired, that my employment is not for any definite period of time, and I may be terminated at any time.
4. I understand that if I state that I have a college degree, and do not have one, that my application will be rejected or, if hired, I will be terminated in accordance with Arkansas Code 21-12-102.
5. I understand that my application may be subject to disclosure as a public record under the Arkansas Freedom of Information Act.
6. I understand that certain jobs may require an acceptable driver’s safety record and that if my current or future driver’s record is unacceptable under the State Driver’s Risk Program, my application may be rejected and, if hired, I may be subject to termination.
7. I understand that I will be required to provide proof of eligibility to work in the United States pursuant to the Immigration Reform and Control Act of 1986 as a condition of any employment.
8. I understand that false, misleading, or incomplete statements could lead to my dismissal as an employee or rejection as an applicant.
9. I also understand that some jobs require special background checks, security clearance, or compliance with other specific college hiring policies prior to my employment, or as a condition of employment; and that failure to meet these requirements may lead to my rejection as an applicant for, or termination from, that job.
10. I affirm that it is my genuine intent to seek, and if offered, employment at East Arkansas Community College and this application is submitted solely for that purpose and for no other purposes.

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.

Applicant Name:

Today's Date:

Social Security Number:

(You are only allowed to attach one document per button.)

Please upload your documents here: