Peru State Application for Employment

Page 1 of 6 - General Information

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General Information
Name Name * First Middle Last
Cell Phone: Cell Phone: - ### - ### ####
Home Phone: Home Phone: - ### - ### ####
Work Phone: Work Phone: - ### - ### ####
Mailing Address Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Are you legally entitled to work in the United States? *

Are you legally entitled to work in the United States? Yes No
Do you have a valid Driver's License *

Do you have a valid Driver's License No Yes - State Issued by: Yes - State Issued by:
Are you related to anyone employed by Peru State College? *

Are you related to anyone employed by Peru State College? No Yes - Employee Name: Yes - Employee Name:
Do you require sponsorship for this position? *

Do you require sponsorship for this position? Yes No
Have you ever been employed by Chadron, Wayne, or Peru State College or the Nebraska State College System? *

Have you ever been employed by Chadron, Wayne, or Peru State College or the Nebraska State College System? No Yes
If yes, when? *

Put N/A if not applicable
If yes, where? *

Put N/A if not applicable
Are you 18 years of age or over? *

Are you 18 years of age or over? Yes No
Do you wish to claim Veteran's Preference? *

Do you wish to claim Veteran's Preference? Yes No

Please note, you may be required to submit substantiating documentation if you are selected as a finalist.