BSC logo
Human Resources

APPLICATION FOR EMPLOYMENT

Birmingham-Southern College does not discriminate on the basis of race, creed, color, national origin, religion, age, sex, handicap, disability, veteran status, marital status, sexual orientation, or any other characteristic prohibited by law in any of its employment practices, including hiring, firing, discipline, promotion and other terms and conditions of employment. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Birmingham-Southern College complies with the Alabama Child Protection Act of 1999 and E-Verify.

Date:
Last Name: First Name: Middle Initial:
Street Address:
City: State: Zip:
Telephone: Cell: Email:
Position Desired: Salary Needed:
Type of work seeking: Date Available:
Will your schedule permit you to work overtime? Yes No

Source of Referral: If current employee, whom?
If "Other," indicate the referral source:

Have you previously been employed with Birmingham-Southern College? Yes No
If so, in what position? When?
What was your reason for leaving?
Have you ever applied for employment with BSC in the past? Yes No
If so, for what position and when?
Are you legally authorized to work in the United States? Yes No
Are you at least age 19? Yes No
Have you ever been convicted of a crime (felony)? Yes No
If yes, give details:

EMPLOYMENT HISTORY

Please list your three most recent employers including full-time and part-time employment. Start with present or most recent employer.

Present Employer: Employment Dates:    From: To:
Employer Address: Phone Number:
Job Title: Was Position Full-Time? Yes No
Supervisor's Name:  
Starting Salary:    $ per Ending Salary:    $ per
Reason for Leaving:
Responsibilities:

 

Past Employer: Employment Dates:    From: To:
Employer Address: Phone Number:
Job Title: Was Position Full-Time? Yes No
Supervisor's Name:  
Starting Salary:    $ per Ending Salary:    $ per
Reason for Leaving:
Responsibilities:

 

Past Employer: Employment Dates:    From: To:
Employer Address: Phone Number:
Job Title: Was Position Full-Time? Yes No
Supervisor's Name:  
Starting Salary:    $ per Ending Salary:    $ per
Reason for Leaving:
Responsibilities:

EDUCATION

School Name & Location Last
Year
Completed
Major
Courses
Diploma
or
Degree
Yes No
Yes No
Yes No

TRAINING AND SKILLS

Use this space to provide additional information about yourself including special skills, second language, membership in professional or civic organizations, certifications, or licenses (as it applies):

Computer Skills:

U.S. MILITARY

Branch of Service: Period of Active Duty: From: To:
Rank at Discharge: Date of Final Discharge:
Were you honorably discharged? Yes No
If not explain.
Duties and special training received:

EMPLOYMENT REFERENCES

Name Title Employer Phone

CERTIFICATION AND RELEASE

I certify that the information I have given in this application for employment is true, correct and complete. I further certify that, in completing this application, I have not withheld any facts or information that would be important or relevant to Birmingham-Southern College in its consideration of my application. I understand that any misrepresentation or omission of information by me will result in my application being denied, or will be cause for my immediate termination in the event such misrepresentation or omission is discovered after I have been employed by the College.

BSC complies with the Alabama Child Protection Act of 1999. I understand that Birmingham-Southern College is required by that Act to obtain a criminal background history check on me. I consent to have this background information check obtained by and released to Birmingham-Southern College. I also agree to provide a complete, functional set of my fingerprints to the BSC campus police.

I also agree to allow Birmingham-Southern College to have a consumer investigative report made as to my employment history, motor vehicle driving record, social security information, and any other information deemed relevant to my potential employment by the College. I am aware that the background report I consent to have prepared may include information obtained from a variety of sources, including but not limited to governmental agencies, courts, law enforcement officials, and any other person, firm or entity having control or possession of any information pertaining to me or my background. I am aware that, if I choose, I may obtain, at my expense, a copy of any consumer investigative report prepared concerning me, if I make a request for such a copy in writing.

I specifically consent to allow Birmingham-Southern College to contact any person whom I have identified in this application, whether as a reference, a former employer or otherwise. By this consent, I hereby release, discharge, exonerate, hold harmless and indemnify BSC (including all its trustees, officers, employees, agents and representatives), together with any other person, firm or entity furnishing information to BSC, from any and all liabilities of every nature and kind, including but not limited to, claims for libel, slander, invasion of privacy, related tort claims, or any other claim or cause of action whatsoever, unless this release is determined to violate the law or the public policy of the State of Alabama, and, in that event, my release will be permitted to the maximum extent allowed by Alabama law.

I understand that Birmingham-Southern College may send this authorization and release to third persons or parties. I agree that a photocopy or facsimile of this document, as signed by me, will be as valid as an original.

In the event I am hired by Birmingham-Southern College, I agree to comply with and abide by all polices and procedures of the College relating to employment and conduct by employees.

Signature: Date: