Employee ID# __________________
Part-time Faculty
Application and Acceptance Agreement
The Department Chair / Contact Person will request official
transcripts, vita and other required credentials.
Please be prepared to submit upon request.
Discipline/Department Applying to work in:
Personal Information
Name
Last:
First:
Middle Initial:
Address
Number and Street:
State:
County:
City:
Zip Code:
Home Phone:
Alternate Phone:
Cell Phone:
E-mail address:
Are you currently an employee at, or have you ever worked for, or been a student at The University of Akron?
Yes
Employee/Student ID:
If yes, please provide your
Have you ever used/and/or been employed under another name?
Yes
No If yes, please list the name(s) used.
Do you have relatives employed at The University of Akron?
Yes
No If yes, please list their name(s).
Have you ever been convicted of a felony, misdemeanor, pleaded no contest, or been placed on probation?
If yes, please explain and provide dates, county, city, state:
Explanation
From: m/d/yy
No
To: m/d/yy
County
Yes
No
City
Are you currently authorized to work in the USA?
Yes
No
Are you currently authorized to work with an employment authorization document?
Yes
No Expiration Date
Will The University of Akron need to file an extension or renewal of your VISA or other work authorization?
Yes
State
No
Failure to provide a work authorization document will prevent you from being employed by the University.
Education
College/University
(Abbreviate if necessary)
HRF006
Part-time Faculty Application Rev 3/2015
Major
(Abbreviate if necessary)
Degree Receive
(Abbreviate if necessary)
Date
m/d/yy
Other Education
Institution
Type of Training/License/Certificate
Location (City, State, County)
Work Experience (within last 5 years)
From: (xx/xxxx)
Month/Year
To:
Month/Year
/
Name of present or most recent employer
Phone
/
Address
Number and Street:
State:
City:
County:
Zip Code:
Department
Supervisor Name
Position Title
Full-time
Part-time
Description of duties
From
Month/Year
To
Month/Year
/
/
Name of past employer
Phone
Address
Number and Street:
City:
State:
Zip Code:
County:
Department
Supervisor Name
Position Title
Full-time
Part-time
Description of duties
From
Month/Year
To
Month/Year
/
/
Name of past employer
Phone
Address
Number and Street:
City:
State:
Zip Code:
County:
Department
Supervisor Name
Position Title
Full-time
Description of duties
HRF006
Part-time Faculty Application Rev 3/2015
Part-time
Date m/d/yy
Teaching Experience (within last 5 years)
From:
Month/Year
To:
Month/Year
/
/
Name of past employer
Phone
Address
Number and Street:
City:
State:
Zip Code:
County:
Department
Supervisor Name
Position Title
Full-time
Part-time
Description of duties/courses taught
From:
Month/Year
To:
Month/Year
/
/
Name of past employer
Phone
Address
Number and Street:
State:
County:
City:
Zip Code:
Department
Supervisor Name
Position Title
Full-time
Part-time
Description of duties/courses taught
Higher Education Instructional History
Total Credit Hours Taught:
Total Number of Semester Terms:
Preferred Teaching Fields or Courses:
Field/Course Name
HRF006
Part-time Faculty Application Rev 3/2015
Field/Course Name
Field/Course Name
SELF IDENTIFICATION OF VETERAN STATUS:
The University of Akron is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974,
as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA) which requires Government contractors to take
affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty
wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as
follows:
Disabled Veteran: (i) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the
receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
(ii) a person who was discharged or released from active duty because of a service-connected disability.
Recently Separated Veteran: any veteran during the three-year period beginning on the date of such veteran's discharge or
release from active duty in the U.S. military, ground, naval, or air service.
Active Duty Wartime or Campaign Badge Veteran: a veteran who served on active duty in the U.S. military, ground, naval or air
service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered
by the Department of Defense.
Armed Forces Service Medal Veteran: a veteran who, while serving on active duty in the U.S. military, ground, naval or air
service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to
Executive Order 12985.
Protected Veterans may have additional rights under USERRA-the Uniformed Services Employment and Reemployment Rights
Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled
to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due
to service. For more information, call the U.S. Department of Labor’s Veterans Employment and Training Service (VETS), toll
free at 1-866-4-USA-DOL.
If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the box below.
As a Government contractor subject to VEVRAA, The University of Akron requests this information in order to measure the
effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.
I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERANS LISTED ABOVE.
I AM NOT A PROTECTED VETERAN.
I CHOOSE NOT TO IDENTIFY.
Acknowledgement
I hereby certify that the information set forth in this application is true and accurate to the best of my knowledge. I understand
that falsified statements on or omissions from this application shall be considered sufficient cause to be dismissed from
employment consideration and cause for dismissal if employed. I realize that past and present employment records, references,
medical and law enforcement records, and/or other information stated by me are subject to inquiry. I hereby authorize The
University of Akron to investigate any of this information and I release said University and my current and former employers from
any liability resulting from said investigation. I am aware that, for positions which require driving a motor vehicle for University
business, an applicant must have satisfactory driving record. I understand that any offer of employment may be contingent upon
my consenting to and successfully passing a criminal background check and/or medical evaluation as may be required by the
University. I understand that no more than twenty-one total credit hours shall be assigned to any part-time faculty member for
any academic year. The academic year is defined as fall and spring semester per UA Rule 3359-20-06/1(3)(c). I agree to comply
with all University rules, regulations and policies. The acceptance of this application by The University of Akron does not
constitute a guarantee of employment.
I agree to be bound by the terms and conditions stated above.
Yes
No
Signature ______________________________________________
Date __________________________
THE UNIVERSITY OF AKRON IS AN EQUAL EDUCATION/AFFIRMATIVE ACTION EMPLOYER
HRF006
Part-time Faculty Application Rev 3/2015