Human Resources / Payroll

Hahn 220B




Application for Employment


Fill out the form online
or download a printable version


Position Applied For:


Name: (Last, First, Middle):


Address: (Street, City, State, Zip Code):










Source used to identify this job opening?


Are you legally entitled to work in the U.S.? Yes No

(i.e. are you a citizen, a permanent resident, or working under the provisions of a visa?)

(If necessary, please explain)

Have you ever been convicted of a crime? Yes No

Convictions are considered in relation to the position applied for and do not automatically disqualify applicants.


Do you wish to claim Veteran's Preference? Yes No

Please note, you may be required to submit substantiating documentation if you are selected as a finalist.


By electronically submitting this document, I attest to the accuracy and truthfulness of the information provided, and I understand that falsification or omission of any information on this application could result in my disqualification from further consideration in the selection process, or, if hired, termination of my employment. I understand that consideration for employment is conditioned upon the results of a background check, and I authorize the Board of Trustees of the Nebraska State Colleges, the College and its agents or assigns to investigate all statements made by me on this application, to conduct a thorough investigation of my background and activities, and I agree to cooperate in such investigation and to release the Board of Trustees and its agents and assigns from all liability or responsibility and of all persons and corporations requesting or supplying such information. I authorize the Board of Trustees of the Nebraska State Colleges, the College and its agents and assigns to contact my cited references and any developed uncited references to make inquires concerning my current and past employment. This authorization will expire six months from the date it is signed. Additionally, upon my termination I authorize the release of reference information on my work.


Wayne State College is an equal opportunity institution. WSC does not discriminate against any student, employee or applicant on the basis of race, color, national origin, sex, disability, religion, or age in employment and education opportunities, including but not limited to admission decisions. The College has designated an individual to coordinate the College's nondiscrimination efforts to comply with regulations implementing Title VI, VII, IX, and Section 504. Inquiries regarding non-discrimination policies and practices may be directed to Kara Vogt, Interim Director of Human Resources, Title VI, VII, IX Compliance Coordinator, Wayne State College, 1111 Main Street, Wayne, NE 68787, (402) 375-7403.


I have read and understand the above conditions.
Last four digits of SSN:
For verification purposes.




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