On-line Application for Employment

Western New Mexico University

Office of Human Resources
Room 110 Juan Chacon
P.O. Box 680
Silver City, NM 88062

Directions:

1. Complete the form below.
2. To email this form press the "E-Mail" button at the bottom of the page. The form will then be emailed to the Human Resources office at WNMU (Sally Beckworth and Charlene Ashburn ) who will process your form.
3. To print and mail this form requires a printer. Once you have completed the form press the "Print Preview" button at the bottom of the page. The "Print Preview" button will display your completed form. You can then print the completed form and mail it to WNMU.
4. Once we receive your application (either online or by mail), we will begin corresponding with you to answer any questions you may have. And, if you have questions at any point during the process, do not hesitate to call (575-538-6328) or email us at one of the addresses mentioned above.

Position Applied for: Date:
Department for Position Applied for:
Referral Source:
Name of Source (If Applicable):
Name:
Last: First: MI:
Social Security Number:

Mailing Address: (Street/PO Box, City,State Zip)

Telephone Number (Include Area Code):
Other Telephone Number:
Email Address (username@domain):
If necessary, best time to call you at home is:
May we contact you at work?  
     If yes, work number and best time to call:
     Work Number: Best time to call:
If you are under 18, can you furnish a work permit?
Have you ever been employed here before?
     If yes, give dates: Fromto
Are you related to anyone currently working at this university?
     If yes, who:
     And their department:
Are you legally eligible for employment in this country?
(Proof of US citizenship or immigration status will be required upon employment.) All offers of employment are conditional upon satisfactory proof of identity and legal ability to work in the United States of America.
Date available for work:
Type of employment desired:
Are you on a lay-off and subject to recall?
If required by the employer, will you undergo pre-employment physical?
Have you ever been bonded?
Have you been convicted of a felony in the last seven (7) years?
(Such conviction may be relevant if job related, but does not bar you from employment.)
     If yes, please explain:
Driver's License Number (If required by job): State:

An Equal Opportunity Employer
EMPLOYMENT HISTORY
List your last four (4) employers, assignments, or volunteer activities; starting with most recent, including military experiences.  Explain any gaps in employment in comment section below.  Please use additional paper if necessary.

Employer:

Phone:

Address: 
Job Title: 
Immediate Supervisor and Title: 
Reason for Leaving: 
May we contact for reference? 
Dates employed:  From to
Final hourly rate or salary:  $ per
Were you employed   Part Time   or   Full Time
Summarize the nature of the work performed and job responsibilities:

 
Employer:

Phone:

Address: 
Job Title: 
Immediate Supervisor and Title: 
Reason for Leaving: 
May we contact for reference? 
Dates employed:  From to
Final hourly rate or salary:  $ per
Were you employed   Part Time   or   Full Time
Summarize the nature of the work performed and job responsibilities:

 
Employer:

Phone:

Address: 
Job Title: 
Immediate Supervisor and Title: 
Reason for Leaving: 
May we contact for reference? 
Dates employed:  From to
Final hourly rate or salary:  $ per
Were you employed   Part Time   or   Full Time
Summarize the nature of the work performed and job responsibilities:

 
Employer:

Phone:

Address: 
Job Title: 
Immediate Supervisor and Title: 
Reason for Leaving: 
May we contact for reference? 
Dates employed:  From to
Final hourly rate or salary:  $ per
Were you employed   Part Time   or   Full Time
Summarize the nature of the work performed and job responsibilities:

Comments (including explanation of any gaps in employment):

Skills and Qualifications
Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our University.

EDUCATIONAL BACKGROUND

A. List last three (3) schools attended, starting with last one. B. List number of years completed. C. Indicate degree or diploma earned, if any. D. Grade Point Average or Class Rank. E. Major and Minor field of study (if applicable).

A.  School 
B.  No. of years completed 
C.  Degree or Diploma 
D.  GPA or Class Rank 
E.  Major    and Minor 

A.  School 
B.  No. of years completed 
C.  Degree or Diploma 
D.  GPA or Class Rank 
E.  Major    and Minor 

A.  School 
B.  No. of years completed 
C.  Degree or Diploma 
D.  GPA or Class Rank 
E.  Major    and Minor 

List any foreign language(s) and choose the selection that best describes your skill.

Language Skill

REFERENCES

List name and telephone number of five business/work references who are not related to you and are not previous supervisors. If not applicable please list three school or personal references who are not related to you.

Name Telephone Years Known

List professional, trade, business or civic associations and any offices held. (Exclude memberships which would reveal sex, race, religion, national origin, age, ancestry or other protected status.)

ORGANIZATION OFFICES HELD

List special accomplishments, publications and awards. (Exclude information which would reveal sex, race, religion, national origin, age, ancestry or other protected status.)

List any additional information you would like us to consider.

Vietnam Era Veteran.       Are you applying for Veteran's Preference?

Please consider filling out the voluntary affirmative action information survey. The information you give will not affect your employment or be used in any selection process. Fill out survey.

We consider applications for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or disability, or any other legally protected status.

Click on the "E-Mail" button to email the application to the Human Resources Office.