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Online Application

Antioch College will review all applications and contact applicants of interest within 30-days of receipt of a completed materials. Application materials will be maintained on file for up to six month, unless the applicant requests otherwise.

		* required field
CONTACT INFORMATION

First Name*	Middle Name	Last Name*

Street Address**

City*

State or Province*

Zip	Country, if other than US

Preferred Contact Number*

Preferred E-mail Address*

Position for which you are applying*

Date Available*

EMPLOYMENT RECORD

List most recent positions first. You may include volunteer work.

Employer 1 - - -

Name of Employer

Employer’s Address

Date Started

Date Left

Title

Duties

May we contact your former employer?
yes no

Former Employer’s Telephone Number

Reason for leaving:

Employer 2 - - -

Name of Employer

Employer’s Address

Date Started

Date Left

Title

Duties

May we contact your former employer?
yes no

Former Employer’s Telephone Number

Reason for leaving:

Employer 3 - - -

Name of Employer

Employer’s Address

Date Started

Date Left

Title

Duties

May we contact your former employer?
yes no

Former Employer’s Telephone Number

Reason for leaving:

Employer 4 - - -

Name of Employer

Employer’s Address

Date Started

Date Left

Title

Duties

May we contact your former employer?
yes no

Former Employer’s Telephone Number

Reason for leaving:

EDUCATION RECORD

School 1 - - -

Name of School, College or University

Major Field of Study

Credential Earned

School 2 - - -

Name of School, College or University

Major Field of Study

Credential Earned

School 3 - - -

Name of School, College or University

Major Field of Study

Credential Earned

School 4 - - -

Name of School, College or University

Major Field of Study

Credential Earned

OTHER

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

Will you now or in the future require sponsorship for employment visa status? (e.g. H-1B visa status?)	yes
	no

Have you ever been convicted of a felony? (*See note below)	yes
	no

If yes, please explain:

REQUIRED SIGNATURE

I hereby state that the information on this application and all other information otherwise provided is true and correct. I understand that any misrepresentations or omissions could result in denial or termination of employment at any time. I also understand that offered employment, I will be employed on an “at-will” basis. This means that either Antioch or I may end the employment relationship at anytime and of any or no reason.
	yes
	no

ATTACH DOCUMENTS

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VERIFICATION CODE (ANTI-SPAM)

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*Notes on Felony Convictions: An applicant for employment with a sealed record on file with the commissioner of probation may answer “no record” with respect to an inquiry herein relative to prior arrests, criminal court appearances or convictions. In addition, any applicant for employment may answer “no record” with respect to any inquiry relative to prior arrests, court appearances and adjudication in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to a superior court for criminal prosecution.

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