Western-Employment-Application-revised-1-16

Western-Employment-Application-revised-1-16



Microsoft Word – Application revised 1-16.docx





400 7th St. N
La Crosse, WI 54601

Name (Last, First, Middle) Please PRINT

Contact Information:

! FULL TIME

! NON-CREDIT

Street: ____________________________________________________________

! PART TIME

! CREDIT

Address: (Please PRINT)

Phone No. (_____)_______________________

Position applying for:
! INSTRUCTOR:

Social Security No. (Optional)

Phone No. (_____)_______________________
Email Address: _________________________

EDUCATIONAL PREPARATION:
Name of Institution

City: _____________________________________

______

______________

State

Zip

Original transcripts showing degrees or credits earned at colleges, universities, or technical colleges must be submitted.
Location

Dates

Date

Attended

Grad.

Number
Degree

Credits

Major

Minor

to

to

to

to

to

TEACHING EXPERIENCE: Chronological - Most recent first. Do not indicate “see resume” on any part of the application form.
FROM
Mo.

`

Yr.

TO
Mo.

PARTYr.

Name of School

Location

Subjects Taught

FULL-

TIME

TIME

OCCUPATIONAL EXPERIENCE - Include Military Service (Chronological - most recent first) Do NOT include teaching experience in this section.
TO

FROM
Mo.

Yr.

Mo.

Total
Yr.

Hours

Employer Name and Address

Title and brief Job Description – Please PRINT

List any significant professional or occupational license(s) you have and forward verification under separate cover.

I hereby certify that the data provided in this application is accurate. I authorize Western Technical College to take any steps necessary to verify this information.

Signature: _______________________________________________

Date : ______________