One College Road, Batavia, New York 14020-9704 (585) 345-6808 Fax: (585) 345-6883

One College Road, Batavia, New York 14020-9704 (585) 345-6808 Fax: (585) 345-6883

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Genesee Community College is a public, open admission, learner-centered college. The College was founded in 1966 and serves a 2,300 square mile region in Western New York. Core values of the college include a commitment to quality, access, innovation, and highly personalized service. The College serves approximately 7,000 full-and part-time credit students each semester and more than 10,000 continuing education students each year. The atmosphere is informal and faculty and staff members work as a team to ensure that the College provides the best educational, social, and cultural opportunities to students and other community members. Genesee takes pride in its many fine programs, technological advances, and community involvement.

Application is for the position of:

GENERAL INFORMATION

Last Name: First Name: Middle:

Home Address: Street City State Zip Code

Home Telephone: Business orCell Phone:

E-mail address:

List any other name which we

may need for checking records:

Employment Availability: Full-Time Part-Time Part-Time Evening

Requested Official Transcript(s): Yes No

Are you authorized to work in the United States: Yes No

Please fill in all requested information. Do not write “see resume.”

PRESENT POSITION

Title or Description:

Name of Employer:

Address of Employer:

Current Employer May be Contacted: Yes No Current Annual Salary $

PROFESSIONAL EXPERIENCETeaching, Educational Administration, Other (List most recent employer first.)

Employer/Institution AddressPosition HeldINCLUSIVE DATES REQUIRED

EDUCATIONAL BACKGROUND(List most recent degree/credits earned first.)

Institution/City/StateDegrees/CreditsMajor/SubjectDate Awarded

HONORS AND AWARDS(List most recent first.)

DescriptionAwarded ByDate

PROFESSIONAL MEMBERSHIP AND AFFILIATIONS

REFERENCES Please provide the names, addresses, and telephone numbers of four references.

Please attach the names, addresses and phone numbers of four professional references if you have not already provided them.

IMPORTANT: This section MUST BE COMPLETED.

Do you have an arrest or criminal accusation currently pending against you? *Yes No

If “YES,” please describe. (If a prior arrest or criminal accusation resulted in a conviction, you may need to disclose this information in response to the next question.

Have you even been convicted of a criminal offense (felony, misdemeanor, or violation)? *Yes No

If “YES,” please describe.

Note: You should answer “NO” if:

Your conviction (felony, misdemeanor, or violation) was sealed by a court, OR

The criminal action or proceeding was terminated in your favor (for example: the action was dismissed either at the initial stage or on appeal; you received an Adjournment in Contemplation of Dismissal and the adjournment period has elapsed; you were acquitted), OR

The proceeding on the criminal offense resulted in a youthful offender adjudication or juvenile delinquency finding which has been sealed/expunged pursuant to the Family Court Act, OR

After completing a treatment program, your plea to a felony or a misdemeanor was withdrawn and you were resentenced to a violation which was sealed by the court, or the completion of the program resulted in a dismissal of all charges by the court.

* Answering “YES” to the question about whether there is a prior felony conviction may or may not preclude employment, depending on the nature of the criminal offense, its relationship to the position sought, and other factors that must be considered before employment may be lawfully denied based on a prior conviction.

Failure to disclose a prior conviction may result in denial of employment or subsequent termination of employment based on falsification of the employment application.

Questions about your status may be directed (anonymously) to the Office of Human Resources.

Signature: Date:

ALL STATEMENTS ARE SUBJECT TO VERIFICATION

NOTICE OF NONDISCRIMINATION

In compliance with the letter and spirit of applicable Federal and State laws and pursuing its own goals of diversity, Genesee Community College is committed to ensuring equal employment and educational opportunity without regard to an individual's race, color, national origin, sex, religion, age, disability, gender, pregnancy, gender identity, sexual orientation, predisposing genetic characteristics, marital status, veteran status, military status, domestic violence victim status, or ex-offender status. This includes, but is not limited to, student admissions, counseling, housing, grading, financial aid, recruitment, application process, hiring, training, disciplinary actions, compensation, promotion, termination, and all other terms and conditions of employment, educational status, and access to college programs and activities.

Genesee Community College will provide accommodations to individuals with disabilities in accordance with the Americans with Disabilities Act. The college will further provide accommodations to ensure the full participation of individuals in college programs, when such accommodations are reasonable and necessary, due to an individual's religion, pregnancy, maternity, or breastfeeding status. Employees, students, applicants or other members of the college community (including but not limited to vendors, visitors, and guests) may not be subjected to discrimination or harassment that is prohibited by law, or treated adversely based upon a protected characteristic. In this context, sexual discrimination includes sexual harassment and sexual violence. All complaints of sexual violence, including assault, stalking, harassment, intimate partner violence, and other forms of sexually intimidating or threatening conduct will be promptly investigated.

Questions and complaints about discrimination or harassment and the College’s compliance with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act of 1990, Title IX of the Education Amendments of 1972, and the Age Discrimination Act of 1975, New York State Human Rights Law, and other federal, state, and local laws should be directed to Gina M. Weaver, Associate Vice President for Human Resources, Affirmative Action Officer and Title IX Coordinator, Genesee Community College, One College Rd, Batavia, NY 14020, Email: , Phone: (585)343-0055, ext.6514. Complaint procedures can be found at Inquiries concerning nondiscrimination laws and compliance requirements may also be directed to the Assistant Secretary for Civil Rights, US Department of Education.

NOTICE OF ANNUAL SECURITY REPORT

A copy of Genesee Community College’s Annual Security Report can be obtained by contacting Human Resources or by accessing the following website This report is required by the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act and contains Clery Act reportable statistics for the previous three years concerning reported crimes that occurred on all Genesee Community College campuses, College Village, and on public property within, or immediately adjacent to and accessible from all GCC campuses. This report also contains institutional policies and procedures concerning campus safety and security, such as policies concerning alcohol and drug use, emergency response, and several other safety and security related matters.

When complete, this application should be forwarded to:

Office of Human Resources

GeneseeCommunity College

One College Road

Batavia, New York14020

Telephone: (585) 345-6808

Fax (585) 345-6883