Application for Employment - Mitchell Technical Institute

Please complete the application form with as much information as possible. You may omit any section that is not pertinent to the job for which you are applying. Any item marked with a red asterisk (*) is a required field. Please note that three references are required. You may choose to upload a resume and/or cover letter; however, that is not required. Please read the disclosure statement, authorize, and sign the document by typing your name into the signature field. Your typed name will serve the same purpose as your signature.

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Position Applying for at MTI (Instructor position, please indicate program): *
NAME
Last: *
First: *
Middle: *
Social Security Number: *
PERMANENT ADDRESS AND CONTACT INFORMATION
Street: *
City: *
State:
Zip: *
Phone Number: *
Cell Phone:
Email Address: *
POSITION INFORMATION
Expected Salary $:
Salary Type:	Hourly Salary
Date Available to Start: *
EDUCATION
HIGH SCHOOL
Name of High School:
Street Address:
City:
State:
Zip:
Are You a High School Graduate?: *	Yes No
Degree/Diploma Received:
GPA:
TECHNICAL SCHOOLS, COLLEGES OR UNIVERSITIES (List most recent first.)
1. Name:
Dates Attended (--/--/-- to --/--/--):
Address:
City:
State:
Zip:
Did You Graduate?:	Yes No
Degree/Minor(s) Received:
GPA:
2. Name:
Dates Attended (--/--/-- to --/--/--):
Address:
City:
State:
Zip:
Did You Graduate?:	Yes No
Degree/Minor(s) Received:
GPA:
3. Name:
Dates Attended (--/--/-- to --/--/--):
Address:
City:
State:
Zip:
Did You Graduate?:	Yes No
Degree/Minor(s) Received:
GPA:
SPECIALIZED TRAINING
List all Licenses, Areas of Certification, or any other special training required for the position applying for:
South Dakota Certificate Information:
Do you have a South Dakota Post Secondary Certificate?:	Yes No NA (Not Applicable)
If not, have you applied?:	Yes No
Type of Certificate(s):
Subject of Function(s):
Date of Expiration(s):
Special abilities and skills that qualify you for the job:
EMPLOYMENT EXPERIENCE
(List in order of last or present employment first. If you currently do not have past or present employment experience, please respond "None" in the required fields for the first employer.)
1. Employer: *
Dates (--/--/-- to --/--/--): *
Position: *
Supervisor: *
Reason for Leaving: *
2. Employer:
Dates (--/--/-- to --/--/--):
Position:
Supervisor:
Reason for Leaving:
3. Employer:
Dates (--/--/-- to --/--/--):
Position:
Supervisor:
Reason for Leaving:
4. Employer:
Dates (--/--/-- to --/--/--):
Position:
Supervisor:
Reason for Leaving:
REFERENCES(Please list at least three)
These references should be from individuals who are or who have been familiar with your professional work and qualified to answer questions concerning this application. (Those applying for instructor positions should include only former school administrators/employers/etc. who are able to assess your professional contribution and/or potential. Please note if any of the references should not be contrated directly, so that we may first obtain your permission.)
1. Reference Name: *
Address and Phone: *
Position of Reference: *
Years Known: *
Relationship to Applicant: *
2. Reference Name: *
Address and Phone: *
Position of Reference: *
Years Known: *
Relationship to Applicant: *
3. Reference Name: *
Address and Phone: *
Position of Reference: *
Years Known: *
Relationship to Applicant: *
4. Reference Name:
Address and Phone:
Position of Reference:
Years known:
Relationship to Applicant:
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DOCUMENTS
Attach Resume:
Attach Cover Letter:
All attached documents must be in .doc, .docx, or .pdf format. All documents not in these formats will be discarded.
OFFICIAL TRANSCRIPT (Instructor Position) - It is your responsibility to request that credentials be sent to provide an official transcript.
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LEGAL INFORMATION
Are you eligible to work in the United States?: *	Yes No
Have you ever been convicted of a felony?: *	Yes No
If yes, please explain:
Mitchell Technical Institute does not discriminate in its employment of policies and practices, or in its educational programs on the basis of race, color, creed, religion, age, sex, disability, national origin, or ancestry. Inquiries concerning the application of Title VI, Title IX or Section 504 may be referred to: Vice-President for Academic Affairs, MTI, 821 North Capital Street, Mitchell, SD, 57301. Telephone (605) 995-3023. Or to: US Department of Education Office for Civil Rights, 10220 N. Executive Hills Blvd. 8th Floor, Kansas City, MO, 64153-1367. Telephone: (816) 880-4202. Fax: (816) 891-0644.
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*MITCHELL TECHNICAL INSTITUTE DISCLOSURE STATEMENT**
By checking "Yes" below authorizes Mitchell Technical Institute to conduct a background investigation and authorizes release of information in connection with my application for employment. This investigation may include such information as criminal or civil convictions, driving records, previous employers and education institutions, personal references, medical records and other appropriate sources. I waive my right of access to such information, and without limitation hereby release the Institute and the reference source from any liability in connection with its release or use. This release includes the sources cited above and specific examples as follows: the local Police Chief or Sheriff, information from the Central Criminal Records Exchange or other data on all criminal convictions or certification that no data on criminal convictions are maintained, information from the State Department of Social Services Child Protection Services Unit and any locality to which they may refer for release of information pertaining to any findings of child abuse or neglect investigations involving me.
I also understand that nothing contained in this application or in the granting of an interview is intended to create an employment contract between Mitchell Technical Institute and myself for employment or for any benefit. I have received no promise regarding employment, and I understand that no such guarantee is binding on Mitchell Technical Institute unless made in writing.
Furthermore, I certify that I have made true, correct and complete answers and statements on this application in the knowledge that they may be relied upon in considering my application, and I understand that any omission, false answered statements made by me on this application or any supplement to it will be sufficient grounds for failure to employ or for my discharge should I become employed with the Institute.
If hired at Mitchell Technical Institute, prior to my first day of work I will be required to verify that I am either a U.S. citizen or a legal resident foreign national.
Applicant's Authorization: *	Yes; I authorize Mitchell Technical Institute to conduct a background investigation and authorize release of information in connection with my application for employment.
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I certify that the information provided in this application is true and complete to the best of my knowledge, and understand that I will be subject to dismissal if any statement in this application is found to be untrue: *	Yes
Signature (Type name; typing your name is the same as signing): *
Date (--/--/--): *
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*The Mitchell Technical Institute is a legal entity operating under the governing structure of the Mitchell School District 17-2 and the laws of the State of South Dakota.
An Equal Opportunity Employer
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