Adjunct Faculty Application

Adjunct Faculty Application
Fiscal Year
Department (check all that apply):
SCIENCES

Business Administration & AccountingSocial Sciences/Criminal JusticeComputer ScienceMathematicsSocial WorkLiterature & LanguagesNursingFine ArtsSciencesPsychologyHumanities & HistoryOther
EDUCATION

Early Childhood EducationTeacher PreparationEducational AdministrationOther
Name
ID #
Address/PO Box
City
State
Zip Code
Home Phone
Cell Phone
E‐mail Address
EDUCATION (All institutions of higher education attended. Copies of unofficial transcripts are acceptable for initial screening

*Official transcripts are required after acceptance of employment

	Institution	Major/Minor	Degree	Date Awarded

TEACHING EXPERIENCE (Institutions, courses, levels, and dates; detailed CV may substitute in this section).

	Institution	Course/Level	Dates

Check all areas of technology for which you are familiar:
Internet

E‐mailOnline ResearchBlogsWebpage DesignForumsChatSmart Phone applications

List Three References who will have knowledge of your current experience, knowledge, skills and dispositions qualifying you to teach at the University level.

	Name	Email Address	Phone Number

Indicate your willingness to teach as to location:

ToppenishTri-CitiesOnlineOther
I understand that an adjunct faculty appointment for one semester does not create an actual or implied contractual promise for additional or future appointments. I certify that the information contained in this application is correct to the best of my knowledge and understand that any falsification, misrepresentation or omission of facts called for herein will result in my disqualification from further consideration or dismissal from employment in accordance with Heritage University policy.
Signature*

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Date

MonthDayYear
Date
File Upload (Resume/CV, Letter of Recommendations, Unofficial Transcript, other documents)

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Official transcripts are required

Email: Human Resources humanresources@heritage.edu

Mail: Heritage University

Att:Human Resources

3240 Fort Road

Toppenish, WA 98948
Date Ordered:
Attached:

YesNo
OFFICE USE ONLY:
Department Chair’s Recommendation:
Notes

I recommend this candidate for adjunct status. He/she is qualified to teach.
Notes
Signature

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Date

MonthDayYear
Date
Name

First NameLast Name
Provost’s Recommendation

I concur with the Chair’s recommendationI concur; however with the following modifications:
Notes
Provost's Signature

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Date

MonthDayYear
Date
Should be Empty:

Adjunct Faculty Application

OFFICE USE ONLY: