Colorado Community College System Application for Instructor Assignments

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CCCS Application for Instructor Assignments

Please tell us about yourself.

Name*

First Name*

Initial*

Last Name*

Preferred Name (if different from above):

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Primary Phone*

Email*

Have you ever been employed within the Colorado Community College Systsem?*

Yes No

For which location(s)

Arapahoe Community College Colorado Community Colleges Online Colorado Northwestern Community College Community College of Aurora Community College of Denver Front Range Community College Lamar Community College Morgan Community College Northeastern Junior College Otero Junior College Pikes Peak Community College Pueblo Community College Red Rocks Community College Trinidad State Junior College The System Office

Mark all that apply

Are you authorized to work lawfully in the United States?*

Yes No

Will you now or in the future require sponsorship for employment visa status, including but not limited to H-1B visa status? *

Yes No

Educational Background

College/University Name

Did you graduate?

Yes No

Diploma/Degree:

Course of study:

College/University Name

Did you graduate?

Yes No

Diploma/Degree:

Course of study:

College/University Name

Did you graduate?

Yes No

Diploma/Degree:

Course of study:

Professional Licenses / Certifications

License Name:

License Number:

License State:

License Expiration Date:

License Name:

License Number:

License State:

License Expiration Date:

Employment Preferences

Employment Desired*

Full-time Part-time Either

Can you work nights?*

Yes No

Please indicate your availability below.*

Please indicate your availability below.
	Morning	Afternoon	Evening	Not Available
Sunday	Please indicate your availability below.: Sunday (Morning)	Sunday (Afternoon)	Sunday (Evening)	Sunday (Not Available)
Monday	Monday (Morning)	Monday (Afternoon)	Monday (Evening)	Monday (Not Available)
Tuesday	Tuesday (Morning)	Tuesday (Afternoon)	Tuesday (Evening)	Tuesday (Not Available)
Wednesday	Wednesday (Morning)	Wednesday (Afternoon)	Wednesday (Evening)	Wednesday (Not Available)
Thursday	Thursday (Morning)	Thursday (Afternoon)	Thursday (Evening)	Thursday (Not Available)
Friday	Friday (Morning)	Friday (Afternoon)	Friday (Evening)	Friday (Not Available)
Saturday	Saturday (Morning)	Saturday (Afternoon)	Saturday (Evening)	Saturday (Not Available)

For which colleges are you interested in working?*

Please mark all that apply

What modality of teaching are you interested in?

Classroom Online

How did you find out about CCCS?

Current Employee Career Fair Newspaper Ad Radio/TV Ad Search Engine

Other: Other Value

Please enter the name of employee who referred you to CCCS.

Employment History

Please list your last 3-4 employers with the most recent employer first.

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Upload a cover letter (optional)

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Employer Name:*

Employer's Address:*

Type of Business:*

Phone Number:*

Job Title:*

Status:*

Part-time Full-time

Are you currently employed with this organization?*

Yes No

Starting Date:*

Ending Date:*

Supervisor Name:*

Supervisor Title:*

Reason for leaving or seeking other employment:*

Brief description of job duties and responsibilities:*

Employer Name:

Employer's Address:

Type of Business:

Phone Number:

Job Title:

Status:

Part-time Full-time

Starting Date

Ending Date:

Supervisor Name:

Supervisor Title:

Reason for leaving or seeking other employment:

Brief description of job duties and responsibilities:

Employer Name:

Employer's Address:

Type of Business:

Phone Number:

Job Title

Status:

Part-time Full-time

Starting Date:

Ending Date:

Supervisor Name:

Supervisor Title:

Reason for leaving or seeking other employment:

Brief description of job duties and responsibilities:

Employer Name:

Employer's Address:

Type of Business:

Phone Number:

Job Title:

Status:

Part-time Full-time

Starting Date:

Ending Date:

Supervisor Name:

Supervisor Title:

Reason for leaving or seeking other employment:

Brief description of job duties and responsibilities:

References

Please list references which you have worked with in a professional or academic setting.

Name:*

Company Name:

Job Title:*

Relationship:*

Email Address:

Phone Number:

Name:*

Company Name:

Job Title:*

Relationship:*

Email Address:

Phone Number:

Name:*

Company Name:

Job Title:*

Relationship:*

Email Address:

Phone Number:

Demographic Information

GENDER:

Male Intersex Female I do not wish to self-identify

BIRTH DATE:

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Month

Day

Year

Disability Status:

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or, if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

Blindness
Deafness
Cancer
Diabetes
Epilepsy
Autism
Multiple sclerosis (MS)
Cerebral palsy
HIV / AIDS
Schizophrenia
Muscular dystrophy
Bipolar disorder
Major depression
Missing or partially missing limbs
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Intellectual disability (previously called mental retardation)

REASONABLE ACCOMMODATION NOTICE

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

DISABILITY (choose one):

I have a disability or previously had a disability I do not have a disability I do not wish to self-identify

ETHNICITY

White Non-Hispanic Black Non-Hispanic Hispanic - Other Asian or Pacific Islander American Indian/Alaskan Native Other I do not wish to self-identify

VETERAN STATUS (choose one):

Not a Veteran Active Wartime or Campaign Badge Veteran Protected Veteran Not a Protected Veteran I do not wish to self-identify