APUS Employment Application
PLEASE PRINT
APUS Confidential Data
Name - Last, First, Initial
Present Address (no P.O. Box)
Date of Application
Street
City
State
Position(s) applying for?
1)
Zip
Area Code & Home Phone
2)
Have you ever been convicted of a felony? (In making an employment decision, we will only consider convictions related to the job.
Please do not complete this question in states of Hawaii, New Hampshire, New Jersey and Ohio.)
No
E-mail Address
Yes - If yes, please explain. ___________________________________________________________________________
_____________________________________________________________________________________________________________.
Are you legally eligible for employment in this country?
Have you been employed by APUS previously?
Date available for work
If yes, what position did you hold and when?
Salary Desired
Type of employment desired:
____
____
____
____
Full-Time
Part-Time
Temporary
Summer Hire
EMPLOYMENT AND MILITARY HISTORY
List employment (inc. U.S. Military Service) starting with present or most recent position. Include all jobs held during last ten (10) years or since age 18, whichever is less.
Dates
Name, Address, Telephone of
Position Title
Supervisor Name and Telephone
(to be used as References)
Employer
From
To
Mo. Yr.
Mo.
Yr.
Reason for Leaving
Ending Salary
Dates
From
Mo. Yr.
Name, Address, Telephone of
Employer
Position Title
To
Mo.
Yr.
Reason for Leaving
Ending Salary
Dates
From
Mo. Yr.
Name, Address, Telephone of
Employer
Position Title
Supervisor Name and Telephone
(to be used as References)
To
Mo.
Yr.
Reason for Leaving
Ending Salary
Dates
From
Mo. Yr.
Supervisor Name and Telephone
(to be used as References)
Name, Address, Telephone of
Employer
Position Title
Supervisor Name and Telephone
(to be used as References)
To
Mo.
Yr.
Reason for Leaving
Ending Salary
Federal, state and municipal laws prohibit discrimination because of race, color, religion, sex, national origin, age, citizenship status, marital
status, sexual orientation, disabled or Vietnam-era veteran status.
1
Rev 3/2009
APUS Employment Application
PLEASE PRINT
APUS Confidential Data
EDUCATIONAL BACKGROUND
Name and Location of School
Years Attended
Degree/Diploma
Major
Graduated (Yes/No)
High School
College/University
College/University
Other
Professional memberships, certificates or licenses held. (Exclude those indicating race, color, religion, sex, national origin, age, handicap, or Vietnam-era veterans’ status).
Please note:
 Persons employed at American Public University System (APUS) have access to confidential information regarding various phases of
Company business. Therefore, the Company follows the usual practice of requiring new employees, at the time of employment, to sign
a proprietary information and conflict of interest agreement. Information concerning competitors’ operations, products, designs or other
proprietary information will not be solicited from an applicant for employment, or from Company’s employees. APUS will honor any
valid post employment restrictions contained in an applicant’s previous employment contract and fully respect the applicant’s duty of
loyalty and non-disclosure to an applicant’s former employer.

In consideration of my employment, I agree to conform to the rules and regulations of APUS, 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 Company or myself. I
understand that no manager or representative of APUS, other than the CEO has any authority to enter into any agreement for
employment for any specified period of time or to make any agreement contrary to the foregoing.

I understand that my employment is contingent upon completing the I-9 Employment Eligibility Verification form as it relates to the
Immigration Reform and Control Act (IRCA) of 1986.

I certify that the answers provided above are accurate to the best of my knowledge and belief. I am aware that failure to complete this
application, intentional omissions or misstatements may result in refusal of employment or discharge.

I, the undersigned applicant, do hereby authorize American Public University System, to perform all checks of my credentials as
allowed by law including, but not limited to, educational background, previous employment, criminal history, and for those applying for
a financial position, a full credit check.
Signature of Applicant
Date
Federal, state and municipal laws prohibit discrimination because of race, color, religion, sex, national origin, age, citizenship status, marital
status, sexual orientation, disabled or Vietnam-era veteran status.
2
Rev 3/2009
APUS Employment Application
PLEASE PRINT
APUS Confidential Data
We consider all applicants for positions without regard to race, color, religion, sex, national origin, age, mental or physical disability,
veteran/reserve/national guard or any other similarly protected status.
To be completed by applicant on a voluntary basis. Not for interview purposes. To be filed separately from application.
In an effort to comply with requirements regarding government recordkeeping, reporting and other legal obligations which may apply,
we invite you to complete this applicant data survey. Providing this information is STRICTLY VOLUNTARY. Failure to provide it
will not subject you to any adverse personnel decision or action. Your cooperation is appreciated.
Please be advised that this survey is not part of your official application for employment. It will not be used in any hiring decision.
The information will be used and kept confidential in accordance with applicable laws and regulations.
Position(s) Applied For:
Application Date:
REFERRAL SOURCE (check all that apply)
Advertisement
Job Fair
Internet
School
Technical Contract Firm
Temp Personnel Services
Name of person who referred you:
Employee Referral
Other
APPLICANT INFORMATION
Sex
Male
Disabled
Female
Race/Ethnic Group
White
Black/African American
Hispanic/Latino
Asian
American Indian/Alaskan Native
Native Hawaiian or Other Pacific Islander
Two or More Races (not Hispanic or Latino)
Yes
No
Any person who (1) has a physical or mental impairment that substantially limits one or more of his or her major life activities, (2) has a record of such an impairment,
or (3) is regarded as having such an impairment. A handicap is substantially limiting if it is likely to cause difficulty in securing, retaining or advancing in employment.
Veteran 100A other
Yes
No
Veteran 100
Yes
No
Armed Forces Service Medal Veteran
(Served in Armed Forces between 8/5/64 and 5/7/75.)
Disabled Veteran
Vietnam Era Veteran
Other Protected Veteran
Special Disabled Veteran
Recently Separated Veteran (3 years)
Other Protected Veteran
Recently Separated Veteran (1 Year)
Federal, state and municipal laws prohibit discrimination because of race, color, religion, sex, national origin, age, citizenship status, marital
status, sexual orientation, disabled or Vietnam-era veteran status.
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Rev 3/2009