Apply for Clinical Instructor of Social Work and Director of Field Education

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Summary
Title:	Clinical Instructor of Social Work and Director of Field Education
ID:	8952
Department:	College of Arts and Sciences
Location:	UDC- Main Campus Van Ness Campus – NW

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Contact Information
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* First Name:
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Application Information
UDC Employee Referral?:
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Attachments
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Application for Employment

An employment application must be completed for each job posting.

APPLICANTS WILL RECEIVE CONSIDERATION FOR POSITIONS, WITHOUT REGARD TO RACE, COLOR, RELIGION, AGE, SEX, EXCEPT WHERE SEX IS A BONAFIDE OCCUPATIONAL QUALIFICATION, SEXUAL ORIENTATION, MARITAL STATUS, INDIVIDUALS WITH DISABILITIES, AND EQUALLY TO DISABLED VETERANS AND VETERANS OF THE VIETNAM ERA.

PERSONAL INFORMATION

* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment):

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* Will you now or in the future require sponsorship from the University of the District of Columbia?:

Yes No

* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):

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* Have you ever worked for the District of Columbia Government before?:

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If Yes, please provide details (Where/When/Job Title):

* Are you related to anyone presently working at the University of the District of Columbia?:

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If yes, please provide the name, position, department, and relationship of each relative employed by the University:

* Are you currently an employee of the University of the District of Columbia?:

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* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?:

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If no, please explain:

EMPLOYMENT DESIRED

* When would you be available to begin work?:

* Type of employment desired:

Full-Time
Part Time
Seasonal

* Hourly rate/salary desired:

* Are you currently employed?:

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If so may we inquire of your present employer?:

Yes No

If presently employed, why are you considering leaving?:

EDUCATION

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location	Did you Graduate? If not, how many years did you complete?	Degree Received
*	*	*

* If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:

EMPLOYMENT HISTORY

Give your full employment record, starting with your current or most recent employment

EMPLOYER 1

* From/To (1)

* Employer Name & Address (1)

* Employer Phone (1)

* Job Title (1)

* Supervisor Name & Title (1)

* Duties (1)

* Reason for Leaving (1)

EMPLOYER 2

From/To (2)

Employer Name & Address (2)

Employer Phone (2)

Job Title (2)

Supervisor Name & Title (2)

Duties (2)

Reason for Leaving (2)

EMPLOYER 3

From/To (3)

Employer Name & Address (3)

Employer Phone (3)

Job Title (3)

Supervisor Name & Title (3)

Duties (3)

Reason for Leaving (3)

REFERENCES List three professional references (not relatives)

Name	Relationship	Phone Number

AUTHORIZATION

The facts set forth in this application and any supplemental information is true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If I am hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.

* Signature (type name):
* Date:

Residency Preference

Are you claiming District of Columbia residency preference for the position indicated above?

	Yes
	No

* Each applicant who claims residency preference is required to establish their bona fide residency by submitted proof on or before the effective date of the appointment. Proof of District residency must be any eight (8) of the following documents showing a current address in the District:

1. Voter Registration
2. Motor vehicle registration
3. Motor vehicle drivers permit
4. Copies of D.C. tax returns certified by the D.C. Office of Tax and Revenue
5. Copies of certified tax returns filed with the U.S. Internal Revenue Service
6. Certified deed or lease or rental agreement for real property
7. Cancelled checks or receipts for mortgage or rental payments
8. Utility bills and payment receipts
9. Bank account records
10. Credit card bills
11. Government issued ID
12. Consumer credit account bills.

I have read and understand the residency preference requirements for this job posting. (All Residency Preference information can be found at the bottom of each job posting under the Information to the Applicant section.)

	Yes
	No

Applicant Self-Identification Form

The University of The District of Columbia is committed to non-discrimination, equal employment opportunity and affirmative action. University programs, employment and educational opportunities are available to qualified persons regardless of actual or perceived actual race, color, religion, national origin, sex, age, disability, sexual orientation, gender identity or expression, family responsibilities, matriculation, political affiliation, marital status, personal appearance, genetic information, familial status, source of income, status as a victim of an intrafamily offense, place of residence or business, or status as a covered veteran, as provided for and to the extent required by District and Federal statutes and regulations.

The University of the District of Columbia is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, voluntary self-reporting or self-identification is the preferred method for collecting data on race, ethnicity and gender.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable federal, state or local laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement.

Gender

	Male
	Female
	I do not wish to disclose this information.

Ethnicity: Do you consider yourself to be Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race.)

	Yes
	No
	I do not wish to disclose this information.

Race: Please select one or more of the following racial categories:

	American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
	Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
	Black or African American: A person having origins in any of the black racial groups of Africa.
	Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
	White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
	I do not wish to disclose this information.

Employment References

* May we contact the employers listed above?

	Yes
	No

Professional References

* May we contact the professional references listed?

	Yes
	No

Veteran's Preference

* Are you veteran?

	Yes, Eligible veteran or Vietnam veteran
	Yes, Disabled veteran, disabled Vietnam veteran, 30 percent disabled veteran, eligible spouse, or eligible survivor
	No

Voluntary Self-Identification of Disability CC-305

Voluntary Self-Identification of Disability

Form CC-305
OMB Control Number 1250-0005
Expires 01/31/2020

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.ⁱ To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

Blindness
Deafness
Cancer
Diabetes
Epilepsy

Autism
Cerebal palsy
HIV/AIDS
Schizophrenia
Muscular dystrophy

Bipolar disorder
Major depression
Multiple sclerosis (MS)
Missing limbs or partially missing limbs

Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Intellectual disability (previously called mental retardation)

Please select one of the options below:

* Do you have a disability

	*		*
	Your Name		Today's Date

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

ⁱ Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Years of Experience

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Education/Credentials

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	PhD or JD