COLLEGE OF MICRONESIA–FSM
P.O. Box 159, Kolonia, Pohnpei FSM 96941
Tel: 320-2480/2481/2482 Fax: 320-2479

EMPLOYMENT APPLICATION

GENERAL INSTRUCTIONS:       Type or print all answers clearly.  Attach College or University transcripts, resume, and three reference letters to application.

POSITION APPLYING FOR:

1. NAME (First, Middle, Maiden, Last)

2. SOCIAL SECURITY NUMBER

USA   

FSM

3. MAILING ADDRESS (P.O. Box Number or Number and Street) Zip Code

4. PHONE NUMBERS

            Home:
            Work: 

5. AGE

6. BIRTHDATE (Month, Day, Year)

7. MARITAL STATUS

8. SEX

9. EDUCATION AND TRAINING (Start with present or most recent education and work back)

Degree

Year

Major

Special qualifications, skills, honors (licenses: operate office machines, data processing equipment, vehicles, construction equipment etc.) 

10. EXPERIENCE: Fill in each block carefully and completely.  Start with your present or most recent employer and work back. Describe your work, listing your most important duties first.  If you supervised others, explain your supervisory responsibilities.  If you worked under a name different from the name in item 1, print the former name at the end of the "Description of Work" box.  Account for all time over the past ten years, including periods of unemployment. Attach additional worksheets as necessary.

From  

To 

Position Title 

Name, Address and Phone number of Employer

Pay Rate/Salary

Hours/Week

Name, Title and Address of Immediate Supervisor 

Reason for Leaving

Number and Kind of Employees Supervised

Description of Work

From 

To 

Position Title 

Name, Address and Phone number of Employer

Pay Rate/Salary

Hours/Week

Name, Title and Address of Immediate Supervisor

Reason for Leaving

Number and Kind of Employees Supervised

Description of Work

From

To 

Position Title 

Name, Address and Phone number of Employer

Pay Rate/Salary

Hours/Week

Name, Title and Address of Immediate Supervisor 

Reason for Leaving

Number and Kind of Employees Supervised

Description of Work

From 

To 

Position Title 

Name, Address and Phone number of Employer

Pay Rate/Salary

Hours/Week

Name, Title and Address of Immediate Supervisor 

Reason for Leaving

Number and Kind of Employees Supervised

Description of Work

From 

To 

Position Title 

Name, Address and Phone number of Employer

Pay Rate/Salary

Hours/Week

Name, Title and Address of Immediate Supervisor: 

Reason for Leaving

Number and Kind of Employees Supervised

Description of Work

11. REFERENCES: List three persons not related to you who have definite knowledge of your qualifications and fitness for the job for which you are applying.  Do not list supervisors you have listed under item 10.

Full Name

Present Address & Phone #

Business or Occupation

12. MAY YOUR PRESENT EMPLOYER BE CONTACTED:  Yes     ¨      No      ¨

13. WHEN WILL YOU BE AVAILABLE? 

14. OFF-ISLAND APPLICANTS:  List name and age of family members who will accompany you.

Name

Age

Relationship

15. LIST ANY HEALTH PROBLEMS THAT WILL NEED SPECIAL ATTENTION:  (regular, prescription, medications etc.)

ATTENTION: READ THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION

Any attempt to practice deception or fraud is grounds for rating you ineligible for employment with the College of Micronesia-FSM or for dismissing you from employment with the College after appointment.  All statements made in this application are subject to investigation, including a check of court records and former employers.  All information pertinent to this application will be considered in determining your present fitness for employment with the College. Please note, this application will only be considered for the job listedon page one. Applications may be kept on file but there is no guarantee. If you want to be considered for another position you must re-submit your application package.

PLEASE SIGN HERE

SIGNATURE OF APPLICANT (Do not print)

DATE (Month, day, year)