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					                                                                 Application for Employment for
                                                               Academic (non-tenure) Appointment

                                                                                                  .

POSITION(s) APPLIED FOR
Position Title                                                       Location                                       Vacancy #


Position Title                                                       Location                                       Vacancy #


Position Title                                                       Location                                       Vacancy #



PERSONAL INFORMATION
Name (Last, First, Middle Initial)

Address (Street, City, State, Zip Code)

Home Phone #                         Cell Phone #                Work Phone #                 E-mail Address

How did you originally find out about this job opening? Please list any specifics to help us identify successful recruiting sources.
 On-Line Job Bank (i.e. jobs.joe.org, academiccareers.com, other) ______________________________
 On-Line Social Network (i.e. FB, LinkedIn,other): ______________________________
 Print Advertisement: __________________________  Professional Association: __________________________
 Referral (by whom?): __________________________               Job Service/CPPC:      __________________________
 Other (Please Explain) : __________________________

Are you authorized to work in the U.S.?  Yes           No
If employed, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control
Act of 1986. The University of Missouri Extension does not guarantee sponsorship for residency.
Are you in any way related to a member of the UM Board of Curators or any present employee of the University?             Yes          No
If yes, indicate the individual’s name, relationship and department.


Are you willing to relocate anywhere throughout Missouri?      Yes  No  Maybe, please explain:

Minimum Acceptable Salary?                                                Date Available for Employment?



EDUCATION – List most recent first (Use supplemental sheet if necessary)
                                                                         Date Attended            Type of                                 Year
     Name of College or University                  Advisor                                                        Major / Hours
                                                                       From            To         Degree                                 Earned




Hours beyond last degree                                             Subject Concentration




UM-UE 118 (Sept 07)
EMPLOYMENT HISTORY – List all employment including military and volunteer service starting with the most
current position held. Show employment history for at least 10 years or from the time you left school. Explain
gaps in employment history. You may attach a resume, but you must complete the employment section. This
information will be used in reference checks. Failure to answer all items in the following section may eliminate you
from further consideration.
 Dates Employed (month/year)                          Position Title
 From:                    To:
 Salary                                               Organization Name/Address
 Start: $      /Month        Final: $        /Month
    Full-time            Part-time, hrs/wk
 May we contact for references                        Supervisor's Name/Title/Phone:   Reason For Leaving:
    Yes                  No
 Duties:




 Dates Employed (month/year)                          Position Title
 From:                    To:
 Salary                                               Organization Name/Address
 Start: $      /Month        Final: $        /Month
    Full-time            Part-time, hrs/wk
 May we contact for references                        Supervisor's Name/Title/Phone:   Reason For Leaving:
    Yes                  No
 Duties:




 Dates Employed (month/year)                          Position Title
 From:                    To:
 Salary                                               Organization Name/Address
 Start: $      /Month        Final: $        /Month
    Full-time            Part-time, hrs/wk
 May we contact for references                        Supervisor's Name/Title/Phone:   Reason For Leaving:
    Yes                  No
 Duties:




 Dates Employed (month/year)                          Position Title
 From:                    To:
 Salary                                               Organization Name/Address
 Start: $      /Month        Final: $        /Month
    Full-time            Part-time, hrs/wk
 May we contact for references                        Supervisor's Name/Title/Phone:   Reason For Leaving:
    Yes                  No
 Duties:




UM-UE 118 (Sept 07)
PROFESSIONAL & COMMUNITY INVOLVEMENT – List most relevant (Use supplemental sheet if necessary)
                                                                                         Awards/
                                   Position or Type of   Duration of Involvement                           Reason for Ending
      Name of Organization                                                              Recognition
                                         Activity          From             To                               Involvement
                                                                                         Received




REFERENCES – At minimum, list current supervisor and/or academic advisor and two professional/academic
references. In addition to work references indicated in the employment history section, the following references may
be contacted.


                                                     Occupation &                 Address              Telephone and E-Mail
           Name              Type of Reference
                                                      Company             (Street, City, State, Zip)         Address




In the box below, please briefly indicate other information about your professional or academic background and
career goals which could be pertinent to an employment decision.




UM-UE 118 (Sept 07)
Per University of Missouri policy HR 504, background checks and criminal convictions will be conducted on the final
candidate for any full-time or part-time position. See policy located in the Human Resources Policy Manual
available at http://www.umsystem.edu/ums/departments/hr/manual/.

        Mail, email or fax the signed application, letter of intent,
        current résumé and copies of academic coursework to:                                     For more information, contact us:

                  MU Extension                                                                         Telephone: (573) 882-4721
                  Human Resource Development
                  University of Missouri Extension                                                     Email: hrdext@missouri.edu
                  205 Whitten Hall
                  Columbia, MO 65211

                  Fax: (573) 882-2595

PLEASE READ CAREFULLY AND SIGN - I certify that the above statements are correct. I understand that any false information (or
omissions) in this application, or its supporting documents, will be sufficient grounds for refusal to hire me or termination without notice. I agree
that all rules, orders, and regulations of the Board of Curators affecting my employment shall constitute a part of my appointment or
employment. I further understand that the University of Missouri has the right to review my education, previous employment, and other
background data.


Applicant’s Signature                                                                               Date __________________

NOTICE OF NONDISCRIMINATION - Per Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, and Section
504 of the Rehabilitation Act of 1973, the University does not discriminate on the basis of race, color, religion, national origin, ancestry, sex, age,
disability, sexual orientation or status as disabled veteran or veteran of the Vietnam Era. Any person having inquiries concerning the University
of Missouri's compliance with these regulations is directed to contact the campus Affirmative Action representative or the Assistant Secretary of
Civil Rights, U.S. Department of Education. Inquiries should be directed to University of Missouri-Columbia, Affirmative Action Office, 143
Heinkel Building, 573-882-4256.

INFORMATION AVAILABLE - MU makes available to applicants a security report of crimes that occurred on campus over the previous three
years. For a copy of this report, contact the University Police Department at 573-882-5923 or access their web site at:
http://web.missouri.edu/~mupdwww




UM-UE 118 (Sept 07)

				
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