Contingent Appointment Application
Office of Human Resources
MAIL Office of Human Resources, 8000 York Road, Towson, MD 21252-0001
/
WEB www.towson.edu/jobs
HR Use:
Keyed by
Date
/ TEL
410-704-2162
/
FAX 410-704-2891
Hiring Department Use: Disposition Code
Position
Department
Vacancy #
PERSONAL DATA: Only Those Applicants To Receive Further Consideration Will Be Contacted.
Have you previously applied for a TU position?
No
Yes
Name
Previous Last Name
Street
Home Phone
City
Cell Phone
State and Zip
Other Phone
County
Email Address
Date Available to Start: ____________
Shift Available? FT_____
PT_____
Days / Hrs available:_________________________
ELIGIBILITY: Information will be verified. Please circle NO or YES and give additional information if required.
Are you legally eligible to work in the U.S.?
No
Yes
Are you currently attending Towson University?
No
Yes
If yes, circle part-time or full-time.
Have you served in the United States Armed Forces?
No
Yes
If yes, list branch.
If employed in position applied for, would you be in a
supervisory relationship to any relative or household
member?
No
Yes
If yes, provide details.
Were you ever employed by TU, USM, or other State
agency?
No
Yes
If yes, list agencies, departments, dates employed.
Are you a State of MD Retiree?
No
Yes
If yes, list agencies, departments, dates employed.
Have you ever been convicted of a civilian or military crime,
other than a minor traffic violation?
No
Yes
If yes and record not expunged, explain fully nature and date of offense(s), name
and location of court(s), disposition(s) or outcome(s), and sentence(s), if any.
No
Yes
If yes and record not expunged, explain fully nature and date of offense(s), name
and location of court(s), disposition(s) or outcome(s), and sentence(s), if any.
A finding of guilty does not necessarily bar employment.
Have you ever received a “probation before judgment”
disposition in a criminal proceeding, other than a minor traffic
violation?
Towson University values diversity and fosters a climate that is grounded in respect and inclusion, enriches the educational experience of
students, supports positive workplace environments, promotes excellence, and cultivates the intellectual and personal growth of the entire
University community.
EDUCATION
High School
College
Graduate
School
Vocational /
Business School
or Other
Did You
Graduate?
School Name and Address
Number Yrs or
Credit Hours
Completed
Major or
Program Type
Type of Degree
or Certification
Name
Street
City, State, Zip Code
Name
Street
City, State, Zip Code
Name
Street
City, State, Zip Code
Name
Street
City, State, Zip Code
Have you received a high school equivalency certificate? No ____
Yes _____  If yes, Name of State: __________________________
LICENSING: If the position for which you are applying requires a license, including driver's license, certification or other authorization to
practice a trade or profession, complete the following section:
Type and/or Class
License Number
Expiration Date
Issuing Authority
State
EMPLOYMENT INFORMATION: Complete ALL information requested. DO NOT state “Refer to Resume,” although you may
include a resume. List your work history beginning with your current or most recent employer. If you held more than one position with an
employer, list each job separately. Include pertinent service in the Armed Forces and related volunteer experience.
Current or Most Recent Employer
Street
Business Type
City, State, Zip
Supervisor’s Name
Position Title
Supervisor’s Title
Salary
Hours per week
Supervisor’s Telephone
Start Date (Month and Year)
If still employed, explain reason for wanting to leave
End Date (Month and Year)
If no longer employed, explain reason for resignation, lay-off or termination
Describe your duties in detail
Describe supervisory duties if any and number of employees supervised
Start date for supervisory duties
End date for supervisory duties
Previous Employer
Street
Business Type
City, State, Zip
Supervisor’s Name
Position Title
Supervisor’s Title
Salary
Hours per week
Supervisor’s Telephone
Start Date (Month and Year)
If still employed, explain reason for wanting to leave
End Date (Month and Year)
If no longer employed, explain reason for resignation, lay-off or termination
Describe your duties in detail
Describe supervisory duties if any and number of employees supervised
Start date for supervisory duties
End date for supervisory duties
Previous Employer
Street
Business Type
City, State, Zip
Supervisor’s Name
Position Title
Supervisor’s Title
Salary
Supervisor’s Telephone
Hours per week
Start Date (Month and Year)
If still employed, explain reason for wanting to leave
End Date (Month and Year)
If no longer employed, explain reason for resignation, lay-off or termination
Describe your duties in detail
Describe supervisory duties if any and number of employees supervised
Start date for supervisory duties
End date for supervisory duties
Previous Employer
Street
Business Type
City, State, Zip
Supervisor’s Name
Position Title
Supervisor’s Title
Salary
Supervisor’s Telephone
Hours per week
Start Date (Month and Year)
If still employed, explain reason for wanting to leave
End Date (Month and Year)
If no longer employed, explain reason for resignation, lay-off or termination
Describe your duties in detail
Describe supervisory duties if any and number of employees supervised
Start date for supervisory duties
End date for supervisory duties
READ THIS SECTION AND SIGN AND DATE BELOW.
Pursuant to Title II of Federal Public Law 101-542 (The Crime Awareness and Campus Security Act of 1990), Towson University prepares and distributes to the University Community an annual
security report, entitled, "A Guide to Crime Awareness and Campus Security". As a prospective employee of Towson University, you may request a copy of the University's most recent security
report. This report contains information regarding the University's policies about the reporting of crimes, access to campus facilities, alcohol and drugs, and sexual assault; provides crime statistics
for Towson University; and explains the police services and crime prevention programs which are available to the University Community. You may obtain a copy of this report by contacting the
Towson University Police Department at 410-704-2505 or by accessing the University Police website at www.towson.edu/police.
I hereby affirm that this application contains no willful misrepresentations and that this information given by me is true and complete to the best of my knowledge and belief. I
understand that any false statements or misleading omissions made by me in connection with my application, or in responding to requests for information, can be sufficient
grounds for my rejection as a candidate for employment or for my immediate discharge.
I authorize persons, schools, my current employer (if applicable), and previous employers and organizations named in this application (and accompanying documents if any)
to provide any relevant information that may be required to arrive at an employment decision. I also hereby release from liability the potential employer and its representatives
for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.
May we contact your current employer?
Yes
No
In order to be hired into the position for which you have applied, you must be a citizen or national of the United States or an alien lawfully admitted for United States
permanent residence, or an alien authorized under United States Immigration Reform and Control Act of 1986.
Under Maryland law, an employer may not require or demand any applicant or prospective applicant for employment or any employee to submit to or take a polygraph, lie
detector or similar test or examination as a condition of employment or continued employment. Any employer who violates this provision is guilty of a misdemeanor and
subject to a fine not to exceed $100. This provision however, does not apply to law enforcement officers as that tern is defined in Maryland's Code, Article 27, Section 727.
I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.
Signature ____________________________________________________________
Date _______________
~ DEMOGRAPHIC INFORMATION ~
The federal government requires that an employer maintain records on the race, sex, and ethnic group of its applicants.
In order to comply with these requirements, Towson University requests that you supply the information sought below.
Completing this form is voluntary. The information is for recordkeeping purposes only and will be kept separate from
your application; it will not affect employment or be used in the selection process.
NAME: _______________________________________________
VACANCY#:__________________________________
DEPT: ________________________________________________
GENDER:
Male
Female
POSITION TITLE: ____________________________________
ETHNICITY
RACE
Hispanic or Latino
White
Not Hispanic or Latino
Black/African-American
I chose not to disclose
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaskan Native
I chose not to disclose
REFERRAL SOURCE
Baltimore Sun
Maryland Job Service
Washington Post
OHR Bulletin Board
NCAA News
World Wide Web
Chronicle of Higher Education
Newsletter / Trade Journal
Other ___________________
Job Fair
TU website
Towson University values diversity and fosters a climate that is grounded in respect and inclusion, enriches the educational experience of
students, supports positive workplace environments, promotes excellence, and cultivates the intellectual and personal growth of the entire
University community.
This information is collected for the purpose of EEO record keeping. Failure to provide this voluntary data will not prevent your application materials
from consideration for employment at Towson University (TU). This information may be inspected, amended or corrected by contacting the Office of
Human Resources. This information is not generally available for public inspection. It will be shared only with other departments at TU, the University
System of MD, the State of MD, the US federal government, and with other entities as permitted by law and/or as authorized by you.