Application for Employment


Position(s) Applying For:

08-120 - Resident Director(s) 08-124 - Grounds Manager (Manager 180)
08-132 - Associate Dean College of Health Sciences (Manager 220) 08-128 - Institutional Research Director (Manager 200)
08-142 - Tech Fee Support Specialist (Manager 170) 08-147 - Assistant Director of CSER/MSA Coordinator (Temporary Position)
08-158 - Pool Manager/Assistant Swimming Coach 08-166 - Temporary Assistant Director of the Teacher Education Center (SUA2)
08-167 - Head Men's Basketball Coach 08-168 - Head Women's Gymnastics Coach
08-09 - Assistant Field Hockey Coach (Part-time Temporary) 08-169 - Assistant Budget Analyst (Manager 160)
08-170 - Clerk 2 -Registrar's Office 08-171 - Assistant Director for Sykes Studen Union (SUA 1)

First Name:
 		Last Name:
 		Middle Name:
Street Address:
City:
 		State:
 		Zip:
Day Telephone:
- -
Cell Phone:
- -
Evening Telephone:
- -
Your Email Address:
Are you a United States Veteran?
Yes   No		 If yes, forward a copy of the DD-214 or similar official verification of your service to Human Resources.
Are you over eighteen (18) years of age?
Yes   No
Citizenship Status:
United States   Resident Alien   Other
Do you have a current drivers License?
Yes    No
Were you ever convicted of a criminal offense or have you ever forfeited a bond or collateral in connection with a criminal charge? (Criminal offences include felonies, misdemeanors, and summary offenses.) A conviction is an adjudication of guilt, concluding determination before a district justice or in criminal court, resulting in a legal penalty such as a fine, sentence, or probation. Omit minor traffic violations.
If “Yes” for conviction, you must list the offense, date of conviction, and deposition. Use separate sheet of paper if necessary.

Yes   No

If "Yes" for conviction, you must list the offense, date of conviction, and deposition.
Failure to disclose this information will disqualify your application from the selection process.
Education and Training
High School Last Attended Name of School:

City:

State:
 Graduate:
Yes  No
Type of Degree or Diploma and Major Subject:
College University or Technical School Name of School:

City:

State:
 Graduate:
Yes  No
Type of Degree or Diploma and Major Subject:
Other Name of School:

City:

State:
 Graduate:
Yes  No
Type of Degree or Diploma and Major Subject:
Other Name of School:

City:

State:
 Graduate:
Yes  No
Type of Degree or Diploma and Major Subject:

SKILLS:
Typing WPM       Word Processing
Shorthand WPM       Data Entry

SPECIAL INTERESTS, TALENTS, SKILLS – Please list and/or explain any other skills you feel will be helpful in determining your qualifications for employment at the University:


Employment Record – (Include periods of Military Service)
Present or Most Recent Employer

From:

Month
Year
(format: YYYY)

To:

Month
Year
(format: YYYY)

Employer:
Street Address:
City:
State:
Zip:
Final Position Title:
Specific Duties:

Supervisor's Name:
Phone No:
- -

May we contact this employer?
Yes  No

Present or Most Recent Employer

From:

Month
Year
(format: YYYY)

To:

Month
Year
(format: YYYY)

Employer:
Street Address:
City:
State:
Zip:
Final Position Title:
Specific Duties:

Supervisor's Name:
Phone No:
- -

May we contact this employer?
Yes  No

Present or Most Recent Employer

From:

Month
Year
(format: YYYY)

To:

Month
Year
(format: YYYY)

Employer:
Street Address:
City:
State:
Zip:
Final Position Title:
Specific Duties:

Supervisor's Name:
Phone No:
- -

May we contact this employer?
Yes  No

Supplement Application Information
This information is used ONLY for Social Equity records, will NOT be matched with your application, and is NOT accessible to the hiring manager(s). Completion of this section is NOT mandatory, however, we appreciate and encourage your cooperation.

Racial DesignationSexAge Range
White, Non-Hispanic
American Indian / Alaska Native
Black, Non-Hispanic
Latino
Asian or Pacific Islander
Native American or Native Alaskan
Other
(Please Specify) 		Male
Female
Under 18
18 - 29
30 - 39
40 - 49
50 - 59
60 - 69
Over 69

Disability Status
If yes, check appropriate status: Yes  No

Hearing Impaired (including hearing loss & deafness)
Visually Impaired (severe impairment and blindness)
Mobility Impaired
Other
(Please Indicate)

Indicate Source
Posting (internal)
Minority Vita Bank Advertisement
Univeristy Employee
Newspaper
 Journal
Friend or Relative
Internet
Other

West Chester University
West Chester University is an affirmative action/equal opportunity employer institution committed to extending equality to all individuals regardless of age, race, religion, gender, handicap, national origin, or veteran status. Any individual having suggestions, problems, complaints or grievances with regard to equal opportunity Affirmative Action or Accommodation is encouraged to contact The Director of Social Equity. 1315 University Avenue, West Chester PA 19383. 610-436-2433.
For more information on the University’s crime statistic which is available in a publication called "Your Safety is Our Concern" please contact Public Safety at (610)-436-3311 or by accessing the following website: http://www.wcupa.edu/dps/clery.pdf.
Electronic Resume Attachment

After submitting your application, would you like the option of
attaching an electronic version of your Resume and cover letter?
(i.e., Word or PDF)

Yes  No

Note: Cover letter, resume, and references must be included in one document.
You will not have the opportunity to resend them individually.

I hereby authorize investigation of all statements contained in this application. I certify that such statements are true, and understand that misrepresentation or omission of facts called for in this form is cause for termination of employment. I also agree: (1) to such examination by a university designated physician as may be required, employment being contingent on the satisfactory passing thereof; (2) If employed, to abide by all regulations of the University.

I have READ and AGREE to the statement above.


  
 
 
  West Chester University of Pennsylvania
West Chester, PA 19383
610-436-1000