Morgan Employment Application – Fill Out and Use

OFFICE OF HUMAN RESOURCES

Morgan State University

1700 E. Cold Spring Lane

Carter-Grant-Wilson Building

Baltimore MD 21251-0001

443-885-3195 (Voice)

443-885-8209 (Fax)

APPLICATION FOR

EMPLOYMENT

Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act Statement

In compliance with the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act,

Morgan State University has made crime statistics available on-line at:

http://www.morgan.edu/Documents/ADMINISTRATION/Finance_Mgmt/police/2011CleryReport.pdf

MORGAN STATE UNIVERSITY

Baltimore MD 21251

Employment Application

Instructions: Please print or write legibly using black ink. Complete application in full. AN INCOMPLETE APPLICATION MAY NOT BE CONSIDERED. Attach resume, if available. Applicants 14 to 18 years of age must submit a Maryland Work Permit prior to employment.

Position(s) for which you are applying:

Date Available for Work:

Type of Employment:

 Administrative

 Faculty

 Staff

 Full-Time

 Part-Time

Name:

Last

First

Middle

Address:

Street

Apt. # and/or PO Box

City

State

Zip Code

In an emergency, notify:

Name

Address

Telephone

Home Phone:

Cell Phone:

U.S. Citizen?

 Yes

 No

If no, VISA Type:

 Immigrant

 Non-Immigrant

Alien Registration #

NOTE: In order to be hired into the position for which you have applied, you must be a citizen or national of the United States, an alien lawfully admitted for United States permanent residence, or alien authorized under United States Immigration Reform and Control Act of 1986.

Were you ever employed by Morgan State University or another Maryland State agency?	 Yes	 No
If yes, list dates and department(s) or agencies:

Do you have any condition which will affect your ability to perform the essential job functions of the position?

 Yes  No

If yes, please explain:

Military Service?	 Yes  No If yes, served from	to		Provide details on separate sheet of paper.
Have you ever been convicted of a crime (excluding misdemeanor traffic violations)?			 Yes	 No

This information may be verified (a record of conviction does not necessarily bar employment). If yes, on a separate sheet of paper list date, place, charge, and disposition.

EDUCATIONAL BACKGROUND

			# of	Course Work		Degree/Diploma/
	Education	Name and Address of School	Years/Credits				Dates Attended
				Major/Minor		Certification Received
			Earned
							From:
High School or GED
							To:
							From:
College or University
							To:
							From:
Graduate School
							To:
Vocational/Business							From:
School or Other							To:
NOTE:	You may be required to submit copies of diplomas, degrees, licenses, certifications, transcripts, and/or relevant documents. If the doctorate degree
	has not been earned, give time spent and number of credits received beyond the master’s degree.

2 | P a g e

EMPLOYMENT HISTORY: Please describe below all positions you have held beginning with your present or most recent employer. Include service in the Armed Forces and volunteer experience. If unemployed a period exceeding six (6) months, please explain below or on a separate sheet of paper. Use separate sheet to list additional employment background. If ever employed under another name please indicate:

The University may contact former employers and schools for references. May we contact your present employer at this time?

Yes No Comments:

If you need more space, please attach an additional sheet.

	Employer:		Dates Employed		Number of Employees Supervised:
	Type of Business:				Your Duties & Responsibilities:
			Beginning:
	Address:
			Month	Year
		Zip Code
			Ending:
	Telephone: (	)
			Month	Year
	Your Title:		Hours Per Week
	Name & Title of Supervisor:
			Salary
	Reason for Leaving:		Starting:$
			Ending: $
	Employer:		Dates Employed		Number of Employees Supervised:
	Type of Business:				Your Duties & Responsibilities:
			Beginning:
	Address:
			Month	Year
		Zip Code	Ending:
			Month	Year
	Telephone: (	)
	Your Title:		Hours Per Week
	Name & Title of Supervisor:
			Salary
	Reason for Leaving:		Starting:$
			Ending: $
	Employer:		Dates Employed		Number of Employees Supervised:
	Type of Business:				Your Duties & Responsibilities:
			Beginning:
	Address:
			Month	Year
		Zip Code	Ending:
			Month	Year
	Telephone: (	)
	Your Title:		Hours Per Week
	Name & Title of Supervisor:
			Salary
	Reason for Leaving:
			Starting:$
			Ending: $

3 | P a g e

MORGAN STATE UNIVERSITY

1700 E. Cold Spring Lane

Baltimore MD 21251

Potential Employee Release Form

I authorize Morgan State University to seek from all of my previous and present schools and employers, and authorize all of my previous and present schools and employers to release to Morgan State University, any and all information pertaining to my educational and employment history.

If I am offered employment, I also authorize the disclosure to Morgan State University of any medical history that may be necessary to verify information provided as a part of the application process.

I release, promise to hold harmless, and covenant not to sue Morgan State University on the basis of its attempts to obtain information from my previous and present schools and employers. I release, promise to hold harmless, and covenant not to use my previous and present schools, employers and health care providers on the basis of the disclosure of information to Morgan State

University.

Name of Applicant

Date

5 | P a g e

MORGAN STATE UNIVERSITY

Demographic Information

In compliance with federal regulations, this University is obliged to maintain records on the race, sex, age, and ethnic origin of all of its applicants. In order to comply with these regulations, Morgan State University is requesting that each applicant provide voluntarily the following information. The information will be detached from your application and will not influence any employment decision. This information is required for government reporting purposes only.

Position(s) Applying For:

Race/Ethnic Origin (Please check only one):		American Indian or Alaskan Native
		Asian
		Black or African American
		Hispanic Origin
		Native Hawaiian or Other Pacific
		Islander
		White
Veteran Status (Please check only one):		Non-Veteran
		Vietnam Era Veteran
		Disabled Vietnam Era Veteran
		Veteran - Other
		Disabled Veteran - Other

MORGAN STATE UNIVERSITY IS AN EQUAL OPPORTUNITY EMPLOYER

SEEKING QUALIFIED CANDIDATES REGARDLESS OF RACE,

COLOR, NATIONAL ORIGIN, RELIGION, SEX, AGE, VETERAN STATUS,

OR PHYSICAL DISABILITY.