Job Application - Formstack

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Job Application

Send application to

E Appoint Tracking Number

Applying for

Applicant Name*

First Name*

Last Name*

Eligibility

Internal Search Only Current Employees Only Current USS Employees Other

This position is open to Pitt State employees only. Must provide 7-digit PSU ID.

PSU ID*

7 digit number

Applicant Email*

Confirm Applicant Email *

Applicant Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Applying from outside of the United States?

Yes

Applicant Address (outside of the US)*

Applicant phone number*

Applicant Phone*

Are you a KPERS retiree?*

Yes No

What is your KPERS retire date?*

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Month

Day

Year

Are you a current KPERS member?*

Yes No

Do you plan to retire within the next 6 months from a KPERS covered position?*

Yes No

What is your anticipated retire date?

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Month

Day

Year

Unclassified

yes no special

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Additional documents to upload?

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Documents such as references, letters of recommendation, samples of professional work, evidence of teaching effectiveness, transcripts, and other

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Additional Comments

Applicant Characteristics

Pittsburg State University is an equal opportunity, affirmative action employer. Various equal opportunity, affirmative action agencies require that Pittsburg State University compile summary data of the applicants for PSU positions. For the purpose of the statistical analysis, we require that you complete this form.

Please be assured that the following information will be kept CONFIDENTIAL by the Office of Institutional Equity. The following information will not be used as criteria for selection, and no hiring authorities will see this form.

Thank you for your cooperation and time as we strive for equal opportunity in higher education through affirmative action.

Name*

First Name*

Last Name*

Applied for

Gender

Male Female

Ethnicity

Caucasian African American Hispanic Asian or Pacific Islander Native American Other

Age

Are you a veteran

Yes No

Are you a veteran of the Vietnam War?

Yes No

Do you have a disability?

Yes No

Please describe your disability

Tell us where you found the position opening?

PSU Website PSU Employee Word of Mouth Advertisement Placement Office Professional Association Listing Bulletin Board

Other: Other Value

I choose not to identify

I choose not to identify

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