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Thank you for your interest in employment with Sampson Community College. It is the goal of the College to strive for excellence and to find the best qualified individuals available. Although not everyone who applies can be hired, your application will be given every consideration. Applications are kept in the active status for six months unless updated by the applicant.

"*" indicates required fields

Step 1 of 6

PERSONAL INFORMATION

Name

First Middle Last

List any additional names used while employed or attending school

Name

Mailing Address*

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary phone number*

Secondary phone number

Email Address*

Are you related to a current SCC employee?*

Yes

Please list name & relationship

Name

Relationship

POSITION OF INTEREST

Position Applying for*

Employment desire*

Full-Time

Part-Time

Either/Both

Have you ever been discharged or asked to resign from a position*

Yes

Please describe in full*

Please put N/A if not applicable.

Have you ever been convicted of a crime, excluding misdemeanors and summary offense, which has not been annulled, expunged or sealed by a court?*

Yes

Please describe in full*

Please put N/A if not applicable.

EDUCATION

Please describe your high school education.*

SCHOOL NAME & LOCATION

DIPLOMA OR GED

YEAR ATTENEDED

DID YOU GRADUATE?

Please describe your post-high school education, including details about any college, university, technical program, or graduate school you have attended.*

SCHOOL NAME & LOCATION

DEGREE EARNED

YEAR ATTENDED

DID YOU GRADUATE?

Please include copies of all transcripts.

Max. file size: 64 MB.

Please include copies of all transcripts.

Max. file size: 64 MB.

Please include copies of all transcripts.

Max. file size: 64 MB.

Please upload your resume here.

Max. file size: 64 MB.

EMPLOYMENT HISTORY

To receive credit for all of your work history and credentials, you must list the information on the application form. Any information that is left off of the application or listed elsewhere will not be considered for qualifying credit.

Employer Name (1)*

Employer Phone Number*

Employer Address*

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date employed*

Type of employment*

Full-time

Part-time

Please describe time worked using years and months.

Starting Salary Rate

Ending Salary Rate

Name of Supervisor*

Title of Supervisor*

Job description*

Reason for leaving*

May we contact your previous employer for references?*

Yes

Employer Name (2)

Employer Phone Number

Employer Address

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date employed

Type of employment

Full-time

Part-time

Please describe time worked using years and months.

Starting Salary Rate

Ending Salary Rate

Name of Supervisor

Title of Supervisor

Job description

Reason for leaving

May we contact your previous employer for references?

Yes

Employer Name (3)

Employer Phone Number

Employer Address

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date employed

Type of employment

Full-time

Part-time

Please describe time worked using years and months.

Starting Salary Rate

Ending Salary Rate

Name of Supervisor

Title of Supervisor

Job description

Reason for leaving

May we contact your previous employer for references?

Yes

REFERENCE

Please provide 3 professional references*

Name

Primary Phone

Company

EDUCATION PHILOSOPHY STATEMENT

Personal Statement*

Education is our mission. Sampson Community College expects high standards from both faculty and staff in oral and written communications. Please write a brief statement stating why you desire employment in the position applied for and why you would be successful in this position.

STATEMENT OF SELECTIVE SERVICES OF REGISTRATION COMPLIANCE

Please select one of the following statements.*

I certify that I am not required to be registered with the Selective Service.

I certify that I am registered with the Selective Service.

Which of the following apply to you?*

I am a female.

I am in the armed services on active duty (Note: Members of the Reserves and National Guard not on full-time active duty must register with the Selective Service.)

I am under the age of 18.

I was born before 1960.

I am a permanent resident of the Trust Territory of the Pacific Island or the Northern Mariana Islands.

None of the above apply

Please select one of the following statements.*

I agree that all information in the above text is true and correct under penalty of law.

I disagree that all of the information in the above text is true and correct under penalty of law.

EQUAL EMPLOYEMENT OPPORTUNITY

Sampson Community College is an equal opportunity institution that encourages diversity, and does not discriminate against race, color, religion, national origin, or ancestry, age, sex, marital status, sexual orientation, disability, or other protected category under North Carolina and Federal law. Compliance with Section 504 of the Rehabilitation Act of 1973 and with the Americans with Disabilities Act (ADA) is a priority of the College. Contact Frankie Sutter, Director of Personnel, concerning issues related to Section 504 and ADA Compliance at (910) 900-4043 or fsutter@sampsoncc.edu.

The sole purpose of the information requested below is to comply with record-keeping, reporting, and other legal requirements. Periodic reports to governmental agencies may be made on the following information. The completion of this form is optional. If you choose to volunteer the requested information, please note that this form is kept in a confidential file and is not part of your application for employment. Inclusion or exclusion of any data will not affect any employment decision. The information will be used to assess how well our recruitment efforts are reaching all segments of the population.

Sex*

Male

Female

Prefer not to disclose

Citizenship*

U.S. Citizen

Resident Foreign National

Non-Resident Foreign National

Ethnicity*

Hispanic or Latino

Non-Hispanic or Latino

Please select one or more race categories listed below.*

White

Black or African American

Native Hawaiian or Other Pacific Islander

Asian

American Indian or Alaska Native

Handicap*

A handicap is any impairment which substantially limits a major life function. This information is optional and will be maintained confidentially. Failure to provide this information will not subject you to any adverse treatment.

Visual impairment/blindness

Hearing impairment/deafness

Cardiovascular disorder

Emotional/mental disorder

Respiratory impairment

Loss or impairment of upper or lower limits

Nervous system/neurological disorder (example: epilepsy)

N/A

CERTIFICATION

Sampson Community College does not pay for interview travel costs and/or relocation.

Applicants for faculty positions who accept an interview will be asked to demonstrate proficiency in oral and written communications in the language in which the assigned courses will be taught.

Applicants for positions which require a specific degree, certification, or license will be required to have official transcripts or documentation on file with the College within 30 days of their hire date.

Proof of citizenship or immigration status will be required of all applicants upon employment. Please select the box below to agree to the follow statements.*

I certify that all of the statements in this application and any attached documents are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I authorize the College or its designee to investigate all statements and information provided on this application or attached thereto. I understand that false information or the omission of relevant information may be grounds for rejection of my application and/or dismissal if employed. I release from all liability and agree to hold harmless, all former employers, references, and persons providing information about my experience, education, and abilities.

I understand that nothing contained in this application or in the interview process is intended to create an employment contract between the college and me.

As part of our standard employment procedures, a criminal background check will be conducted on all applicants prior to extending an offer of employment. Please check that you acknowledge this requirement.*

I understand I will be required to have a criminal background check conducted.

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PERSONAL INFORMATION

POSITION OF INTEREST

EDUCATION

EMPLOYMENT HISTORY

REFERENCE

EDUCATION PHILOSOPHY STATEMENT

STATEMENT OF SELECTIVE SERVICES OF REGISTRATION COMPLIANCE

EQUAL EMPLOYEMENT OPPORTUNITY

CERTIFICATION

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