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Personal Data 
Name________________________________Social Security #__________-_______-__________ Address________________________________________________________________________ City________________________ State______________ Zip______________________________ 
Telephone Numbers: Day________________________ Night_____________________________ 
Position you are applying for?_______________________________________________________ 



Education 

References 
Please give the name of three persons you are not related to, whom you have known at least one year. 


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Work Experience 
This section must be completed entirely. List all work experience, paid or unpaid, beginning with your most recent job. Include military, volunteer or other jobs you wish to be considered as qualifications for the job you are seeking. If more space is needed, additional pages can be added. 
Company_______________________________ Employed from ___________ To __________ Address _______________________________ Phone________________________________ Supervisor______________________________ 
Full-Time
Part-Time Your Title_______________________________ Ending Wage __________________________ Duties ________________________________________________________________________ 
_______________________________________________________________________________ Reason for Leaving ______________________________________________________________ 
Company_______________________________ Employed from ___________ To __________ Address _______________________________ Phone________________________________ Supervisor______________________________ 
Full-Time
Part-Time Your Title_______________________________ Ending Wage __________________________ Duties ________________________________________________________________________ 
_______________________________________________________________________________ Reason for Leaving ______________________________________________________________ 
Company_______________________________ Employed from ___________ To __________ Address _______________________________ Phone________________________________ Supervisor______________________________ 
Full-Time
Part-Time Your Title_______________________________ Ending Wage __________________________ Duties ________________________________________________________________________ 
_______________________________________________________________________________ Reason for Leaving ______________________________________________________________ 
Company_______________________________ Employed from ___________ To __________ Address _______________________________ Phone________________________________ Supervisor______________________________ 
Full-Time
Part-Time Your Title_______________________________ Ending Wage __________________________ Duties ________________________________________________________________________ 
_______________________________________________________________________________ Reason for Leaving ______________________________________________________________ 
Please describe any additional experience, training, or skills that qualifies you for this job. (Be Specific.)___________________________________________________________________________________________ 


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Please Read Before Signing 
I understand that the University will rely upon the information I have provided in this application and during my interview. I certify that I have had sufficient time to carefully fill out this application and the answers given herein are true and complete to the best of my knowledge and that my application does not contain any errors, omissions, misrepresentations, or any information which could be interpreted as misleading. I understand that any error, omission, misrepresentation, or misleading information in my application or interview(s) or during the application process will be grounds for termination of employment or rescinding of my offer of employment. I authorize the employers, schools, or persons named above to release to the University all information regarding my employment, character and qualifications, and agree to hold all persons who provide information to the University harmless with respect to the information they may give, receive or publish. 
I understand that nothing contained in this employment application creates a contract between the University and myself for employment or any other benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the University. If an employment relationship is established, I understand that my employment is at-will and my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the University or myself. I also understand that I am required to abide by all of the rules and regulations of the University and the State of Nevada. 
Signature of Applicant Date 
NOTE: As a condition of employment you will be required to produce original documents establishing your identity and authorization to work, and to complete the U.S. Immigration and Naturalization Service Form I-9.

To download the form for completion, click here.