Fillable Printable New Employee Application Form - Indiana

New Employee Application Form - Indiana

Employment Application Form

Indiana University is an Equal Opportunity/Armative Action Employer.

Have you ever been convicted of a criminal oense that has not been expunged, restricted,

or sealed by a judge?

r yes r no

Convicted means you were declared guilty by a judge or you pleaded guilty in court. A conviction may

have even taken place if you did not pay a ne or spend time in jail or in prison. A conviction could have

been for either a misdemeanor or a felony. Certain trac oenses rise to the level of a misdemeanor

or felony and must be declared; examples include driving under the inuence, driving on a suspended

license, reckless driving, leaving the scene of an accident, and vehicular homicide. A criminal history

investigation is done on each new employee, and employment with the University is conditional, sub-

ject to the ndings of a criminal history investigation. Answering yes to this question does not auto-

matically disqualify you for employment; however, information obtained from the investigation will be

used in the employment review process.

Please read and sign the following statement:

I certify that all information provided in all my application material is true.

I understand that any false statement made herein is sucient reason for

rejection of this application or termination of subsequent employment

regardless of date of discovery. I authorize the university to investigate all

statements made in my application material for employment. I authorize

such educational institutions and employers and others (and their agents

or employees) to respond to questions concerning information given in

this application material and I further release from liability such former

employers, institutions, or persons providing such information to the

university.

I understand that an oer of employment from Indiana University will be

contingent on the receipt and evaluation of the background check report.

Disclosure of convictions within this application does not automatically

disqualify me for employment; however, information obtained from the

investigation will be used in the employment review process.

I agree that the university may require my participation in and contribution

to retirement programs while employed. I also understand that the direct

deposit of my paycheck to my personal checking or savings account is a

condition of employment. I understand that no oer of benets such as

a pension plan, insurance, vacation, or salary rate is nal until cleared by

Human Resources, and fully approved by appropriate university ocials.

I have carefully read and understand this statement and, by my written or

electronic signature below, note such.

Notice:

Indiana University is an Equal Opportunity/Equal Access/Armative Action

institution. IU intends to maintain an alcohol and drug-free workplace and

to comply with the Drug Free Workplace Act of 1988 and its amendments.

To that end, all employees must comply with the University’s Substance

Free Workplace policy. Annual security and re safety reports containing

policy statements and crime and re statistics for Indiana University

campuses are available at protect.iu.edu/police/crimestats/.

Name (print)

(Last) (First) (Middle)

Are you over 18 years of age? r yes r no

If required for the position,

do you hold a valid driver’s license? r yes r no

Are you legally authorized to work in the United States? r yes r no

Are you a current Indiana University employee? r yes r no

If yes, date started, position, and location

Have you ever been employed by Indiana University in the past? r yes r no

If yes, your name (if dierent), date started and left, position, and location

If yes, you must disclose for each oense: date, charge, city, state and disposition:

(Include type of oense (e.g., misdemeanor, felony) and judgment (e.g., guilty, conditional dismissal).)

UHRS 7/2013

All questions and statements must be answered in full or your application will not be processed.

(Signature of Applicant) (Date)

Special skills/foreign languages/certications/licenses

Special equipment/computer hardware or software/industrial machinery/video or teleconferencing

WORK HISTORY

List your work history for at least the past seven years. Begin with the most recent position. A supplemental work history form is available if needed.

From To Name of Firm Address Duties Involved Supervisor Salary Reason for Leaving

EDUCATION

Highest Grade University or College Major/Degree

Name City State Completed Graduated? and year obtained for verication purposes only

High School

or GED r yes r no

University

or College r yes r no

University

or College r yes r no

University

or College r yes r no

(Last) (First) (Middle)

UHRS 7/2013

Name (print)

Address

Phone #s

(Street) (City) (State) (Zip code)

(Home) (Business) (Cell)

E-mail

What type of work will you accept? (check all that apply)

r Full Time r Part Time

r Temporary r Seasonal

r Professional r Maintenance r Custodial r IT/computer

r Dining Service r Clerical r Technical r Other (please specify)

r Days

r Evenings

r Weekends