SIERRACOLLEGE

PARTTIME

FACULTYAPPLICATION

5000ROCKLINROAD
ROCKLINCA95677

AnEqualEmploymentOpportunity/AffirmativeActionEmployer

This application will be used by a committee to select applicants for interviews; it is our first
contact with you as an applicant for employment. Please print in ink or type your responses
completely and accurately. Print "N/A" on any section that is not applicable. You may
respond to the sections on attachments using a word processor, as long as your responses
are clearly labeled and in the same format as established by this application. Resumes and
otherrelevantdocumentsmaybeincludedwithyourapplicationmaterials. Resumesare not
accepted in lieu of this application. If this application is unsigned it will be given no further
consideration. Please follow all instructions carefully. You must complete all sections of
thisapplicationinordertobeconsideredforthisposition.

Return this form to the Sierra College Personnel Office prior to the closing date and time
statedonthejobopportunityannouncement.

Name ____________________________________________________________________________
Last
First
Middle

Address____________________________________________________________________________
Number
Street

____________________________________________________________________________
City
State
ZIP

HomePhone
__________________________ BusinessPhone__________________________

MessagePhone __________________________

EMailAddress__________________________

Positionforwhichyouareapplying_______________________________________________________

Pleasecheckthelocation(s)atwhichyouarewillingtowork:

__RocklinCampus__RosevilleGateway__NevadaCountyCampus__Tahoe/Truckee

Pleasecheckthehoursyouarewillingtowork:

__Evening

__Daytime

__Weekends

COPIESOFTRANSCRIPTSMUSTBEATTACHEDORSUBMITTEDBYDEADLINE

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PARTTIMEFACULTYAPPLICATION

SECTIONI:MinimumQualifications:

Applicantsmustsatisfytheminimumqualificationsasrequiredbylawinordertobe
consideredforthisposition.

Checktheappropriatespaceinoneofthefollowingcategories:

YES
NO

____
____
MINIMUMQUALIFICATIONSDoyoumeetthedegreeand/or

experiencerequirement.NOTE:AMastersdegreeinthesubjectarea
isrequiredforacademiccourses.ABachelorsdegreeandtwoyears
ofoccupationalexperienceinthedisciplineORanAssociatesdegree
andsixyearsofoccupationalexperienceinthedisciplineisrequired
forvocationalcourses.

NOTE:

Copiesoftranscriptsmustbeattachedtotheapplication.
(Photocopiesareacceptable)

____

____

CREDENTIALS(Pleaseattachacopyofthecredential)
DoyoupossessaCaliforniaCommunityCollegeCredentialinthe
Area(s)listedinthejobannouncement?NOTE:TheCalifornia
CommunityCollegeCredentialisnotrequired,butmaybeused
ifyoureceivedthelifetimecredentialpriorto1990.

ThefollowingappliesonlyifyoucheckedNOinBOTHminimumqualificationsandcredentialsin
thesubjectarea.

____
____
EQUIVALENCYDoyoubelieveyouhavetheequivalentas
describedabove,ineitheraforeigndegreeorotherequivalency?

(Ifyoucheckyesinthiscategory,contactthePersonnelOfficeforproceduresto
documentyourclaimofequivalencyandsubmitdocumentationwithyourapplication).

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SECTIONII:AcademicPreparation:

PARTTIMEFACULTYAPPLICATION

LICENSESAND/ORCERTIFICATIONSCURRENTLYHELD:

POSTHIGHSCHOOLPREPARATION:

Ifmorespaceisneeded,useattachments,clearlylabeledandinthesamesequenceandformat.

NameofAccreditedInstitution___________________________________________________________

Address_____________________________________________________________________________

DatesofAttendanceFrom________/________/_______To________/________/________

TypeofDegreeAwarded________________________________________________________________

Major______________________
SemesterUnitsCompleted___________________

Major______________________
SemesterUnitsCompleted___________________

NameofAccreditedInstitution___________________________________________________________

Address_____________________________________________________________________________

DatesofAttendanceFrom________/________/_______To________/________/________

TypeofDegreeAwarded________________________________________________________________

Major______________________
SemesterUnitsCompleted___________________

Major______________________
SemesterUnitsCompleted___________________

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PARTTIMEFACULTYAPPLICATION

SECTIONII:AcademicPreparation:(continued)

ADDITIONALCOURSEWORKAND/ORCONTINUINGEDUCATION:

Ifmorespaceisneeded,useattachments,clearlylabeledandinthesamesequence

andformat.

AccreditedInstitution/SponsoringAgency__________________________________________________

Address______________________________________________________________________________

DatesofAttendanceFrom________/________/_______
To________/________/________

Course/Topic__________________________________________________________

UnitsCompleted__________________________

AccreditedInstitution/SponsoringAgency__________________________________________________

Address______________________________________________________________________________

DatesofAttendanceFrom________/________/_______
To________/________/________

Course/Topic__________________________________________________________

UnitsCompleted__________________________

AccreditedInstitution/SponsoringAgency__________________________________________________

Address______________________________________________________________________________

DatesofAttendanceFrom________/________/_______
To________/________/________

Course/Topic__________________________________________________________

UnitsCompleted__________________________

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PARTTIMEFACULTYAPPLICATION

SECTIONIII:EducationalWorkExperience:

Pleaselistallteaching,counseling,nursingorothereducationalexperience,starting
withthemostrecent.Ifmorespaceisneeded,useattachments,clearlylabeledand
inthesamesequenceandformat.

Institution/District______________________________________________________________________

Address______________________________________________________________________________

FullTime_____
PartTime_____%(ofafulltimeposition)

DatesFrom__________________
To_______________________

CoursesTaught/ServicesProvided(OnePerLine)
No.ofSemesters

______________________________________________________________ _________________

______________________________________________________________ _________________

______________________________________________________________ _________________

______________________________________________________________ _________________

Institution/District______________________________________________________________________

Address______________________________________________________________________________

FullTime_____
PartTime_____%(ofafulltimeposition)

DatesFrom__________________
To_______________________

CoursesTaught/ServicesProvided(OnePerLine)
No.ofSemesters

______________________________________________________________ _________________

______________________________________________________________ _________________

______________________________________________________________ _________________

______________________________________________________________ _________________

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PARTTIMEFACULTYAPPLICATION

SECTIONIV:OtherRelatedWorkExperience:

Listotherworkexperiencerelativetothisposition,startingwiththemostrecent.
IncludeU.S.militaryandrelevantvolunteerorunpaidworkexperience.Ifmore
spaceisneeded,useattachments,clearlylabeledandinthesamesequenceand
format.

Employer/Organization____________________________________________________

Address________________________________________________________________

Position________________________________________________________________

Fulltime________
Parttime______%(ofafulltimeposition)

Dates:From_________________
To____________________

Describeyourduties______________________________________________________

Employer/Organization____________________________________________________

Address________________________________________________________________

Position________________________________________________________________

Fulltime________
Parttime______%(ofafulltimeposition)

Dates:From_________________
To____________________

Describeyourduties______________________________________________________

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PARTTIMEFACULTYAPPLICATION

SECTIONV:References:Namesandaddressesofpersonswhoarefamiliarwithyour
previouseducationaland/oremploymentexperiencewhomwemaycontact.

NameofReference_____________________________________________________________________

Title/Position_________________________________________________________________________

Address______________________________________________________________________________

_____________________________________________________________________________________

PhoneNumber(_____)___________________________

NameofReference_____________________________________________________________________

Title/Position_________________________________________________________________________

Address______________________________________________________________________________

_____________________________________________________________________________________

PhoneNumber(_____)___________________________

NameofReference_____________________________________________________________________

Title/Position_________________________________________________________________________

Address______________________________________________________________________________

_____________________________________________________________________________________

PhoneNumber(_____)___________________________

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PARTTIMEFACULTYAPPLICATION

SECTIONVI:Certification:Itismandatorythatyouprovidetheinformationinthissection.Itwillbe
usedsolelyforlegalsuitabilitypurposes.

YES NO

Have you ever been discharged or forced to resign from a position? (If your
answer is yes, please explain in detail on a separate sheet of paper, and include
dates, places, and the nature of each event).
Federal Immigration laws (Immigration Reform and Control Act of 1986) require
employers to verify and attest to the employment eligibility of new employees to
work in the United States. This requirement applies to all applicants. Are you
legally authorized to work in the United States?

PLEASEREADCAREFULLYANDSIGNTHEFOLLOWING:

By signing this application below, I understand that I hereby give my permission and authorization for
Sierra College to verify information concerning my past employment history and educational record,
employment suitability issues, professional and personal references regarding work habits, conduct,
particular skills and assignments, dependability, honesty, length(s) and type(s) of prior employment,
suitability for reemployment, court conviction records, and/or other issues which may have a bearing
onthedecisiontooffermeemploymentatSierraCollege.

The information and answers I have included in this application are true and correct to the best of my
knowledge. I understand that omitting or misrepresenting any information required for this
applicationwillresultinSierraCollege'srejectionofmyapplication,orterminationofmyemployment.
Ialsoaffirmthattheinformationandanswerswerepreparedsolelybyme.

AtthetimeofaninterviewtestingrelatedtothejobdutiesforwhichIamapplyingmayberequested.

I understand that neither filing this application nor being granted an interview will create an
employment contract between me and Sierra College. I also understand that if I am offered
employment,itwillbeasaprobationaryemployee,andthatduringtheprobationaryperiodeitherIor
Sierra College may terminate our employment relationship for any reason. If this application is
unsigneditwillbegivennofurtherconsideration.

________________________________________
______/______/______

SIGNATURE
DATE

SIERRACOLLEGETHANKSYOUFORYOURINTERESTINOURDISTRICT.

ATSIERRACOLLEGEWEFACILITATELEARNING,INSPIRECHANGEANDBUILDCOMMUNITY.

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PARTTIMEFACULTYAPPLICATION

SECTION VI(b): Criminal History Statement: It is mandatory that you provide the information in this section. It will be
usedsolelytodetermineemploymenteligibility.

All employment offers are subject to a background clearance which includes, at a minimum, a careful evaluation of criminal
history information to ensure prospective employees are clear of any criminal history that would indicate a risk to the safety or
security of the campus community. The District will not deny employment to any applicant solely because the person has been
convicted of a crime. The District, however, may consider the nature, date, and circumstances of the offense as well as whether
the offense is relevant to the duties of the position. All applicants who are offered employment will be provided with a LiveScan
Request form and be required to submit fingerprints electronically at a California Department of Justice LiveScan Station. The
applicant is required to bear the cost of the LiveScan (typically $42).

#1.

Have you ever been convicted (including a plea of guilty or no contest which resulted in a criminal conviction)
of a crime? (Exclude misdemeanor convictions for marijuana-related offenses more than two years old;
notwithstanding any of the preceding, you should not disclose convictions that are over two years old as of
the date that you complete this application for violation of health and safety code sections 11357, 11360, 11365
or 11550, as those statues related to marijuana prior to January 1, 1976 or a statutory predecessor to those
statutes.)

YESIfYES,complete#2and#3below
NO
IfNO,godirectlyto#3below

CONVICTIONSYOUMUSTINCLUDE:
Youmustincludeaconvictionevenifyouhavereceivedareleaseper1203.4ofthePenalCode.
You must include a conviction for a Vehicle Code violation if it resulted in a misdemeanor or felony conviction.
(Examples:drivingundertheinfluence,hitandrun,recklessdriving)

CONVICTIONSYOUDONOTNEEDTOINCLUDE:
You do not need to include a conviction for a Vehicle Code violation classified as an infraction or a parking
violation.(Examples:simplespeeding;runningastopsign,anyparkingviolation)
You do not need to include a conviction for an offense committed as a juvenile if the record has been sealed in
accordancewithsection1203.45ofthePenalCode.
Youdonotneedtoincludeaconvictionforamarijuanaoffenseiftheoffenseoccurredmorethantwoyearsago
and the record has been expunged or is eligible to be expunged pursuant to section 11361.5 of the Health and
SafetyCode.

#2.

List details of each conviction including offense date, arresting agency, code section violated and
dateprobationendsorended.Useothersideofpaperifmorespaceisneeded.

OffenseDate

ArrestingAgency

DateProbation
EndsorEnded

CodeSectionViolated

#3.

By signing below, I certify that I have listed all of my criminal convictions except for those exempted by law. I
understand that if I provide false information about a conviction or fail to disclose a conviction I will be
disqualified for employment. I further understand that if a substantive error or omission of a conviction is
revealed after employment begins, I will be subject to immediate dismissal for cause.

___________________________________________

____________________________

Signature

Date Signed

Print Full Name Legibly (one letter per box)

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PARTTIMEFACULTYAPPLICATION

SECTIONVI:SIERRACOLLEGEEQUALEMPLOYMENTOPPORTUNITYFORM

The information on this form is for statistical purposes only. Your cooperation in providing the requested information is
appreciated.Thisinformationiskeptseparateandconfidentialandisnotprovidedtotheselectioncommittee.Completion
ofthisformisvoluntaryandwillneitherenhancenordetractfromyouropportunityforemploymentwithSierraCollege.

POSITIONTITLE:________________________________________________________________________________________

SEX(PleaseCheckOne):
Male
______ Female ______

RACE/ETHNICITY(PleaseCheckWhatApplies):

AMERICANINDIAN/ALASKANNATIVE:(OriginsinanyoftheNativeAmericanIndianpeoplesofNorthAmerica.
Pleasespecifytribalaffiliation)

ASIAN/PACIFICISLANDER:

AsianIndian

EastIndian/Pakistani:(OriginsinanyoftheoriginalpeoplesoftheIndiansubcontinent)

WestAsian:(OriginsofWestAsianAmericansfromtheAfghan,Arabian,Iranian,andTurkishCountries)

___ Cambodian

___ Chinese:(OriginsinanyoftheoriginalpeoplesofChina)

Filipino:(OriginsinanyoftheoriginalpeoplesofthePhilippineIslands)

__ Guamanian

__ Hawaiian

__ Japanese

__ Korean

__ Laotian

__ Samoan

__ Vietnamese

OtherAsian:(Pleasespecify)
BLACK/AFRICAN:(NotofHispanicOrigin)
HISPANIC:(IncludesBlackindividualswhoseoriginsareHispanic)

MexicanAmericans/Chicano:(PersonsofMexicancultureororigin,regardlessofrace)

LatinAmerican/Latino:(PersonsofLatinAmerican,SouthAmerican,Cuban,PuertoRicanculture,regardlessofrace)

OtherHispanic/Spanish:(PersonsofSpanishcultureororigin,notincludedinanyoftheotherHispaniccategoriesabove)

(PleaseSpecify)
WHITE/CAUCASIAN:(OriginsinanyoftheWhiteracialorethnicgroupsofEurope,NorthAfrica,ortheMiddleEast)

CHECKANYAPPLICABLE:

DISABLED: (Persons with a physical or mental impairment which substantially limits one or more major life activities, or who has a record of such

impairment,orwhoisregardedashavingsuchimpairment)

VIETNAMERAVETERAN:(Personwhoservedonactivedutyforaperiodofmorethan180days,anypartofwhichoccurredbetween8/5/64and5/7/75,

and was discharged or released with other than a dishonorable discharge, or was discharged or released from active duty for a serviceconnected

disability,ifanypartofsuchactivedutywasperformedbetween8/5/64and5/7/75)

DISABLEDVETERAN:(PersonentitledtodisabilitycompensationunderlawsadministeredbytheVeteran'sAdministrationforDisability)

HOWDIDYOULEARNABOUTTHISPOSITION?

Advertisement(Pleasespecifysource)

CommunityAgency(Pleasespecify)

CraigsList
__
EdJoin
__
FriendorColleague
JobLine

ProfessionalOrganization(Pleasespecify)

SelfInitiated

SpecialRecruitment

VacancyAnnouncement

Other(Pleasespecify)

SIERRACOLLEGEISANEQUALEMPLOYMENTOPPORTUNITYEMPLOYER

EQUALEMPLOYMENTOPPORTUNITYOFFICE
5000RocklinRoad,Rocklin,CA95677
EEO6/07