Continuing Education Instructor Application

Required fields are marked with **

To Applicant
We appreciate your interest in MCC and assure you that we are sincerely interested in your qualifications. Your cooperation in providing a clear understanding of your background and work history will aid us in considering you for a position that best meets your qualifications. The College is an Equal Opportunity Employer. None of the information disclosed on this application will be used by the College in an unlawful, discriminatory manner or purpose. If you need an accommodation in order to complete the application process, contact the Continuing Education Office.
NOTICE OF NONDISCRIMINATION
Metropolitan Community College does not discriminate on the basis of race, creed, color, gender, religion, national origin ancestry, sexual orientation, marital status, age, disability, veteran status, or other protected status. MCC highly values diversity.
Employment Record
Do not write "see resume instead of filling in the blanks. List your employment history starting with present or most recent employer. Up to 5 employers can be listed. If more space is needed, attach a resume with full work history. Any organizations which would indicate your race, creed, color, gender, religion, national origin ancestry, sexual orientation, marital status, age, disability, veteran status or other protected status may be excluded.
Position applying:
**What position are you applying for?:

 
Canadate Information:
**First Name:

 
Middle Initial:
**Last Name:

 
**Street Address:

 
**City:

 
**State:

 
**Zip Code:

 
**Email Address:

 
**Day Phone Number:

 
Evening Phone Number:
**Do you have any relative(s) or member of your household in our employ?:
 
If yes, please list person’s name(s) and relationship:

Age group(s) willing to teach
**Check all that apply:
 
Where would you be willing to teach
**Check all that apply:














 
**Days/times you are available to teach. (check all that apply):
 
Teaching Background
**Are you at least 18 years of age?:  
Do you have a teaching certificate registered in Nebraska?:

If yes, areas of specialized education and level for which you are prepared:

**Are you legally eligible for employment in this country?:
(Proof of U.S. citizenship or immigration status will be required upon hiring, as required by the Immigration Reform and Control Act of 1986.)  
Specific Teaching Subject Area(s):
Subject 1:

Subject 2:

Subject 3:
Course Information
**Please provide us with a title and a 2-3 sentence description of each class you wish to teach. Remember… an appealing title and a well-written description can help “sell your class!” If the class requires a lab fee, please include the estimated fee in your description:

 
Education
**Select highest grade completed:

 
Enter names of schools attended beyond high school below:
School Name:
City:
State:
No. of Credits Completed:
Degree or Diploma:
Major:
Minor:

School Name:
City:
State:
No. of Credits Completed:
Degree or Diploma:
Major:
Minor:
EMPLOYMENT RECORD 1
Do not write “see resume” instead of filling in the blanks. List your employment history starting with present or most recent employer. Up to 5 employers can be listed. If more space is needed, attach a resume with full work history. Any organizations which would indicate your race, creed, color, gender, religion, national origin ancestry, sexual orientation, marital status, age, disability, veteran status or other protected status may be excluded.
**Employer Name:

 
**Employer Address:

 
**Employer City:

 
**Employer State:

 
**Employer Phone Number:

 
**Employer Date From:

 
**Employer Date To:

 
**Position Held:

 
**Supervisor:

 
**Duties Performed:

 
**Reason for Leaving:

 
**Other Name(s) you have worked under for this employer or (N/A):

 
**May we contact this employer?:
 
EMPLOYMENT RECORD 2
Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Phone Number:

Employer Date From:

Employer Date To:

Position Held:

Supervisor:

Duties Performed:

Reason for Leaving:

Other Name(s) you have worked under for this employer or (N/A):

May we contact this employer?:
EMPLOYMENT RECORD 3
Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Phone Number:

Employer Date From:

Employer Date To:

Position Held:

Supervisor:

Duties Performed:

Reason for Leaving:

Other Name(s) you have worked under for this employer or (N/A):

May we contact this employer?:
EMPLOYMENT RECORD 4
Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Phone Number:

Employer Date From:

Employer Date To:

Position Held:

Supervisor:

Duties Performed:

Reason for Leaving:

Other Name(s) you have worked under for this employer or (N/A):

May we contact this employer?:
EMPLOYMENT RECORD 5
Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Phone Number:

Employer Date From:

Employer Date To:

Position Held:

Supervisor:

Duties Performed:

Reason for Leaving:

Other Name(s) you have worked under for this employer or (N/A):

May we contact this employer?:
Attach Resume **Attach Resume:
(Please see Employment Record above)
 
 
PLEASE READ CAREFULLY
I certify that the above statements are correct to the best of my ability. I understand that any false, misleading, or intentionally omitted information on this application (or its supporting documents) may be sufficient grounds for refusal to hire or termination without notice. I authorize Metropolitan Community College to review my education, previous employment, and other background information (where doing so is allowed by law) as may be necessary in arriving at an employment decision. I hereby release all persons who provide any such information to the College from any liability.
I hereby understand that (unless otherwise defined by applicable law) any employment relationship with this organization is of an “at will” nature, which means the Employer may discharge the Employee at any time with or without cause. I also understand (that as required by law) I will be required (if hired) to furnish documentation establishing my identity and eligibility to work in the United States.
**Your Signature:

 
**Todays Date: