Application for Employment
cooperative extension
Campus 4040
colorado state university
fort collins, colorado 80523-4040
phone (970)-491-7866
fax (970)-491-3722
at work for you
INSTRUCTIONS: READ CAREFULLY BEFORE FILLING OUT THIS FORM
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This application will be photocopied. It must be LEGIBLE,
COMPLETED IN BLACK INK OR TYPED, AND SIGNED by
the applicant.
Answer each question clearly and completely.
This application and supplementary material must be
received by advertised deadline date via mail, fax or hand
delivery. No e-mailed applications will be accepted.
It is the applicant’s responsibility to provide complete
transcripts of all college studies. Transcript(s) MUST be
received by deadline and show proof of degree(s)
conferred.
1. Position Title (position for which you are applying)
4. Name
(Last)
(First)
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Please do not exceed these four pages. If you need
additional space attach separate pages.
Please be certain you meet the requirements listed in the
vacancy announcement.
Receipt of your application may not be acknowledged, and
immediate contact with your references may not be made.
Notify Colorado State University Cooperative Extension
(CSUCE) about any change in your availability, status,
address, or other circumstances that might affect your
application.
2. Vacancy Announcement Number
(Middle)
3. E-Mail Address
5. When will you be available?
6. Number and Street, R.D., or Post Office Box Number
7. City
State
9. Home Telephone (Area Code – Number)
Zip Code
8. Acceptable salary range:
Business Telephone (Area Code – Number)
Cell Phone (Area Code - Number)
10. Name, Address, and Phone Number of someone who will always know where and how to contact you.
11. Education (Attach copy of college transcript covering all college course work.)
Name of College or University
Major
Dates Attended
From
To
Type of
Degree
You might say Colorado is our campus.
Year
Earned
GPA
12. Summary of course work relevant to the position for which you are applying.
13. Other schools or training (for example, trade, vocational, armed forces, or business). List the name and location of each school,
dates attended, subjects studied, certificates, and any other pertinent data.
14. Experience (List all positions held since college, beginning with current position and working backwards.)
May inquiry be made of present and previous employers regarding your character, qualifications, and record of employment?
Yes
No
Previous employer(s):
Yes
No
Present employer:
A
Dates of Employment (month, year)
From:
Salary or earnings
per
Starting $
Ending $
per
Exact Title Position:
To:
Avg. hrs
worked per
week:
Name and Title of Immediate Supervisor:
Place of employment
City:
State:
Number and type of
employees supervised:
Type of business or organization
(education, extension, marketing)
Name of Employer (firm, organization, etc.) and Address (including ZIP code):
Area code and phone no.:
Reason for wanting to leave:
Description of work:
B
Dates of Employment (month, year)
From:
Salary or earnings
Starting $
per
Ending $
per
Avg. hrs
worked per
week:
Name and Title of Immediate Supervisor:
Area code and phone no.:
Reason for wanting to leave:
Description of work:
Exact Title Position:
To:
Place of employment
City:
State:
Number and type of
employees supervised:
Type of business or organization
(education, extension, marketing)
Name of Employer (firm, organization, etc.) and Address (including ZIP code):
C
Dates of Employment (month, year)
From:
Salary or earnings
per
Starting $
Ending $
per
Exact Title Position:
To:
Avg. hrs
worked per
week:
Name and Title of Immediate Supervisor:
Place of employment
City:
State:
Number and type of
employees supervised:
Type of business or organization
(education, extension, marketing)
Name of Employer (firm, organization, etc.) and Address (including ZIP code):
Area code and phone no.:
Reason for wanting to leave:
Description of work:
D
Dates of Employment (month, year)
From:
Salary or earnings
per
Starting $
Ending $
per
Exact Title Position:
To:
Avg. hrs
worked per
week:
Name and Title of Immediate Supervisor:
Place of employment
City:
State:
Number and type of
employees supervised:
Type of business or organization
(education, extension, marketing)
Name of Employer (firm, organization, etc.) and Address (including ZIP code):
Area code and phone no.:
Reason for wanting to leave:
Description of work:
E
Dates of Employment (month, year)
From:
Salary or earnings
per
Starting $
Ending $
per
Avg. hrs
worked per
week:
Name and Title of Immediate Supervisor:
Area code and phone no.:
Reason for wanting to leave:
Description of work:
Exact Title Position:
To:
Place of employment
City:
State:
Number and type of
employees supervised:
Type of business or organization
(education, extension, marketing)
Name of Employer (firm, organization, etc.) and Address (including ZIP code):
15. The vacancy announcement lists the required and desirable training and experience for the position. Prepare a statement that will
relate your qualifications to each of the required and desired criteria.
16. Why are you interested in working for Colorado State University Cooperative Extension?
17. What are your professional and educational goals?
18. Special skills (with machines, foreign languages, etc.)
19. Memberships in professional or scientific societies:
20. Honors, awards, and fellowships received:
21. Certifications/licenses held:
22. As the job requires traveling throughout the county/state, do you have an automobile, use of an automobile, or the ability to travel as
indicated?
Yes
No
23. References. List four persons who are not related to you and who collectively are familiar with your academic training, personal
background, job performance, and professional potential. Please distribute the “Reference Forms” to these individuals and have
them return the forms to CSUCE.
Name and
Relationship
Address
(Street, City, State, ZIP)
Occupation and
Phone Number
ATTENTION – THIS STATEMENT MUST BE SIGNED
Read the following paragraphs carefully before signing this Statement.
Any false answer to any question in this Statement may be grounds for not employing you, or for dismissing you after you begin work.
The successful candidate for a Colorado State University Cooperative Extension position will be required to undergo an
investigative background check. A criminal record will not necessarily bar a potential employee, but will be
considered as it relates to the specifics of the position for which you have applied.
AUTHORITY FOR RELEASE OF INFORMATION
I have completed this Statement with the knowledge and understanding that any or all items contained herein may be subject to
investigation prescribed by law or Presidential directive, and I consent to the release of information concerning my capacity and
fitness by employers, educational institutions, law enforcement agencies, and other individuals and agencies, to authorized
employees of Colorado State University Cooperative Extension.
CERTIFICATION
I certify that all of the statements made by me are true, complete,
and correct to the best of my knowledge and belief, and are
made in good faith.
SIGNATURE (sign in ink)
DATE