Application for Employment


Position(s) Applying For:
17-01 - Athletics Director (View Description)
17-03 - Web Content and Social Media Specialist (View Description)
17-07 - Bilingual (Spanish) Admissions Counselor (SUA 2) (View Description)
17-12 - TRIO Talent Search Coordinator (9-month) (SUA1) (View Description)
17-14 - Director of Sponsored Programs and Grants Management (Manager 170) (View Description)
17-15 - Director of Strategic Communications and Marketing (Manager 200) (View Description)
17-16 - Strength and Conditioning Coach (View Description)
17-18 - Retention Specialist (SUA 2) (View Description)
17-19 - Tenure-Track Assistant/Associate Professor of Early Childhood/Special Education (View Description)
17-20 - Project Assistant- (Non-represented Manager 160) (View Description)
17-21 - Grant-Funded Program Coordinator, Keystone Honors Academy (View Description)

First Name:
Last Name:
Middle Name:
Street Address:
City:
State:
Zip:
Primary Telephone:
- -
Alternate 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.
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 in connection with a criminal charge? (Criminal offenses include felonies and misdemeanors.) 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

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.

Race Sex Age Range

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White/Caucasian
Two or More Races
Male
Female
Other
Under 18
18 - 29
30 - 39
40 - 49
50 - 59
60 - 69
Over 69

Ethnicity
Hispanic or Latino
Not Hispanic or Latino
 
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
University Employee
Newspaper
Journal
Friend or Relative
Internet
Other

Are you currently employed by Cheyney University?
Yes
No

Are you currently receiving a pension from SERS or PSERS?
Yes
No

Are you currently classified as a SUA employee at one of the fourteen University’s?
Yes
No

Cheyney 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 office of Social Equity.
For more information on the University’s crime statistic, please contact Public Safety at (610)-399-2405 or by accessing the following website: http://www.cheyney.edu/public-safety/Crime-Statistics.cfm.
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

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.