CORNELL COOPERATIVE EXTENSION
EMPLOYMENT APPLICATION
CORNEL CO
IE EXTENSION
ASSOCIATION EPLOYMENT APPLICATION
Cornell Cooperative Extension is an affirmative action/equal opportunity employer and educator
Directions: Type or print, using black ink.
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Please note that the Employment Record, Education and References sections do not need to be completed if a previously
submitted resume provides all of the specific requested information. If there is information that is not on your resume,
please be sure to provide that information in order to ensure your application materials will be considered fully.
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Sign the completed application.
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If you need additional space attach a supplemental sheet.
Name (Last) (First) (Middle)
Date of application
GENERAL
Present address (street, city, state, zip code)
Phone no. (evening)
Address where you may be contacted if different from present address
Alternate phone no.
Email address
Are you a veteran?
U.S. citizen?
(If yes, list special education received)
If no, are you legally authorized to work in the U.S.?
If hired, you will need to provide proof of citizenship or legal right to work in the U.S.
Have you ever been convicted of any criminal offense other than minor traffic violations?
(If yes, please explain. A criminal conviction will be considered only in relation to the job for which you are applying. Seriousness
and nature of the offense, time elapsed, and rehabilitation will be taken into account.
POSITION
Position applying for
Salary range you will consider
Date available
$
Where did you learn about this position opening?
newspaper
specify _____________________________
school/career center
specify _____________________________
Cornell Cooperative Extension
source ______________________________
state employment
office ______________________________
Internet
specify _____________________________
other
specify _____________________________
Cornell Cooperative Extension associations provide equal