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Employment Application

The data you enter will be encrypted and securely transmitted to Viterbo University.

Complete this employment application carefully and completely to assist us in giving you full consideration for employment at Viterbo University.

Position applying for  

How did you learn about us?
(Identify the name of the publication, school, agency, person, etc.)

Personal Information

First name    Middle name    Last name

Street/RR/PO Box   City   State   Zip
Home phone   Email 
If you are currently working, may we call you at work? If so, work phone
Have you attended school or been employed under a different name? If so, name(s) used

Employment History
1. Start date   Year     End date   Year Position Held
Employer name and address
Supervisor name, title, and phone
2. Start date   Year       End date   Year Position Held
Employer name and address
Supervisor name,title, and phone
3. Start date   Year       End date    Year Position Held
Employer name and address
Supervisor name, title, and phone

Have you ever been employed at Viterbo University?
Have you ever taken classes at Viterbo University?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?

Have you ever been convicted of a criminal offense?
(A conviction record is not an automatic bar to employment with Viterbo University.)



I CERTIFY that all of the information entered by me on this form and on any other documents submitted in support of my application for employment are true and correct. I understand that I am required to notify Viterbo University of any change in the information I have given on this form and that failure to do so may be considered to be concealment of information. I understand and agree that any misrepresentation or concealment of information, regardless of when it is discovered, will be sufficient grounds for dismissal from, or refusal of employment.

I UNDERSTAND THAT any faculty, staff, or student user of Viterbo University’s facilities or services is required to comply with the Campus Security Act and Sex Crimes Prevention Act of 2002, including self-registration with appropriate state agencies. Failure to comply with this requirement, if applicable to me, may jeopardize my status as a Viterbo employee.

I AUTHORIZE Viterbo University to request, and also authorize each former/current employer, education institution, and other persons or references listed, to furnish at any time, any information that may be sought concerning me or my work habits, character, skill, or any other data required, whether in connection with my application for employment, or for completion of required background investigations.

I UNDERSTAND THAT employment with Viterbo University is purely voluntary, based upon the consent of the university and the employee. Therefore, this application does not create a contract of employment.

Online Signature

I AGREE, as a condition of hire, to provide document(s) establishing proof of identity and employment eligibility in compliance with the Immigration Reform and Control Act of 1986, as it may be amended from time to time.

Online Signature

As part of our hiring background and investigation, we obtain consumer reports or prepare an investigative consumer report. The investigative consumer report may consist of contacting listed prior employers to verify your employment history. It may also include, but not be limited to, credit information reports, criminal history reports, and driving history records. Under the provisions of the Fair Credit Reporting Act (15 U.S.C. §§ 1681-1681u), as amended, before we can request such reports, we must have your written permission to obtain the information. You have the right, upon written request, to a complete and accurate disclosure of the nature and scope of the investigation. You are also entitled to a copy of your Rights Under the Fair Credit Reporting Act.

I HEREBY GRANT Viterbo University permission to obtain the referenced information. 

Online Signature 

Viterbo University shall not discriminate against any employee, or applicant for employment, because of age, race, religion, color, handicap, gender, physical condition, developmental disability, sexual orientation, national origin, marital status, or military reserve duty, unless otherwise permitted by law. The Annual Safety and Security Information Report required by the Student Right-to-Know and Campus Security Act and its amendments is available upon request from Viterbo University’s Student Development Department.