Faculty applicants: Return completed application to department/college.
If "no" a work permit may be required at time of hire.
No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable
accommodation?
Yes
No
If not, describe the functions that cannot be performed:
Page 1
Are you presently out on bail, or on your own recognizance, pending trial?
5151 State University Drive, Los Angeles, CA 90032-8534
Human Resources Management, Admin. Bldg., Room 606
Application For Employment
Last Name
First Name
E-Mail Address
(Number & Street)
(City & State)
Address
www.calstatela.edu
POSITION
Position Title
M.I.
Home Phone
(Zip Code)
Department
No
Yes
Yes
If hired, can you provide evidence that you are legally authorized to work in the U.S. ?
If you are related to anyone employed by Cal State L.A., please supply the following:
EDUCATION
List schools attended other than high school (include military training and/or related courses):
Name
Relationship
Cell Phone
Are you over 18 years of age?
(NOTE: A conviction is not an automatic bar to employment. An arrest without conviction cannot serve as a basis for denial of
employment. Each case will be considered on its own merits.)
Do you have any existing CSU employment?
ADDITIONAL INFORMATION
If yes, please list:
Yes
No
You are required to give information on all felony or serious misdemeanor convictions. A conviction
includes a plea, verdict or finding of guilt, regardless of whether sentence was imposed by the court.
Misdemeanor convictions for possession of marijuana that are more than two years old need not be
listed. Minor traffic citations and incidents which occurred before your 18th birthday may be
excluded.
Name and Location
Major
Credits Completed
Degree
Semester Units
Quarter Units
Awarded? Y/N
Awarded
Degree
Have you ever been convicted of a criminal offense?
If yes please explain:
PROFESSIONAL ACHIEVEMENTS/PUBLICATIONS: Most recent publications or mem