subject_line
Application for Employment
Southwest Kingston University
Personal Information
First Name
*
Last Name
*
Address 1
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Address 2
City
*
State
*
Postal Code
*
Phone
*
Email Address
*
Position Applying For
*
Program Coordinator
Adjunct Faculty - RN to BSN
Adjunct Faculty - MBA in Healthcare Management
General Applicant
Salary Requirements
Date available to begin work.
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Education
Please state all College or University degrees earned. Please begin with the most recent first. Send official copies of your transcipts to
Southwest Kingston University, 333 Texas Street, Suite 520
Shreveport, LA 71101
University 1
From
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To
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Major/Minor
Highest Degree Earned
BS
MA
JD
PhD
Other
If other, please indicate type of degree earned.
University 2
From
+
To
+
Major/Minor
Highest Degree Earned
BS
MA
JD
PhD
Other
If other, please indicate type of degree earned.
University 3
From
+
To
+
Major/Minor
Highest Degree Earned
BS
MA
JD
PhD
Other
If other, please indicate type of degree earned.
University 4
From
+
To
+
Major/Minor
Highest Degree Earned
BS
MA
JD
PhD
Other
If other, please indicate type of degree earned.
Employment History
List the two most recent positions you have held. Your CV should list all positions.
Employer #1
Address
Phone
From (MM/YYYY)
To (MM/YYYY)
Position
Salary
Supervisor/Manager
May we contact this employer?
Yes
No
Reason for Leaving
Employer #2
Address
Phone
From (MM/YYYY)
To (MM/YYYY)
Position
Salary
Supervisor/Manager
May we contact this employer?
Yes
No
Reason for Leaving
References
List at least three (3) references. University officials will contact these references when appropriate.
Name
Title
Phone
Email Address
Name
Title
Phone
Email Address
Licensure/Certification
Name
Title
Phone
Email Address
License/Certification
State Issued
Expiration Date
License No.
Supplemental Documents
Please submit a cover letter.
*
Please submit a copy of your resume/CV.
*
Please submit a copy of any licenses or certifications. (Optional)
Please upload a copy of university transcripts. (Optional)
Release Authorization
I authorize Southwest Kingston University to obtain any information relating to my activities from current and previous employers and education institutions. This information may include any achievement, performance, attendance, disciplinary actions and/or educational-related issues. I release any and all individuals from all liability for damages that may result to me on account of compliance with this authorization.
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Yes, I authorize Southwest Kingston University
No, I do not authorize Southwest Kingston University
Signature
I hereby certify that the information in this application is complete and correct to the best of my knowledge and belief; that the omission of information or submission of false information will void my application for employment and any actions based upon it. I understand that any offer of employment tendered to me is contingent upon my agreement to abide by the Rules and Regulations of the Board of the Southwest Kingston University.
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Southwest Kingston University
333 Texas Street, Suite 520
Shreveport, LA 71101
877-475-8338