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Adjunct Instructor Candidate Pool Application Form

UW-Stout is an equal employment opportunity/affirmative action employer. We value diversity of people, ideas, and experiences and actively seek applications from women and minorities.


Please note that all adjunct candidate pool applicants are required to submit (via surface mail) official copies of all transcripts, licenses, certificates, and other professional credentials, including an up-to-date curriculum vita. Send supporting documents (or request official copies to be sent) to: Outreach Services, Adjunct Instructor Candidate Pool Application, PO Box 790, University of Wisconsin-Stout, Menomonie, Wisconsin 54751. You may also download and print out the PDF version of this form and include it with your supporting records.

This solication and your submission of an application is not an offer of employment. Your application will be reviewed, along with the credentials that you submit by mail, for possible inclusion in the University of Wisconsin-Stout pool of potential adjunct instructors. You will be notified by eMail when all materials supporting your application have been received. Only if an opening occurs for which your education, experience, and interest may be a suitable match will you be contacted for further engagement in the application/selection processes.

Fields with a Red Flag Flagged field must be completed to submit your application.
Review the required fields carefully to ensure you have the information you need before you begin completing the form.

INTEREST AREA

Area of expertise for which you believe your education and experience qualify you to teach in an adjunct capacity. Please be specific. Refer to http://www.uwstout.edu/programs for descriptions of current UW-Stout program and course offerings. More info...

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PERSONAL INFORMATION

First name Flagged field Last name Flagged fieldMiddle Initial

Street address Flagged field CityFlagged field StateFlagged field Zip Flagged field

Phone – day contact: Flagged field xxxxxxxxxxxxxxxxxxxx

eMail address: Flagged field xxxx

EDUCATION

Provide information about the degrees you have earned.

Institution where highest degree was earned:
Flagged field Located in City, State: Flagged field

Degree earned: Flagged field Date graduated (mm-yyyy): Flagged field

Major: Flagged field Minor:

Institution 2:
Located in (City,State):

Degree earned: Date graduated (mm-yyyy):

Major: Minor:

Institution 3:
Located in (City,State):

Degree earned: Date graduated (mm-yyyy):

Major: Minor:

EXPERIENCE

Position most related to adjunct content area(s):     Position was at UW Stout?   Yes  No

Began: (mm-yyyy): Flagged field xx Ended: (mm-yyyy): (if currently employed here, leave blank)

Employer: Flagged field Location (City/State): Flagged field

Your title: Flagged field

Supervisor: Flagged field xxx Supervisor phone: Flagged field

Please describe your duties as related to your desired adjunct instructional areas:

Flagged field

Second most related position:     Position was at UW Stout?   Yes  No

Began: (mm-yyyy): Ended: (mm-yyyy):

Employer: Location (City/State):

Your title:

Supervisor: xxx Supervisor phone:

Please describe your duties as related to your desired adjunct instructional areas:

Third most related position:     Position was at UW Stout?   Yes  No

Began: (mm-yyyy): Ended: (mm-yyyy):

Employer: Location (City/State):

Your title:

Supervisor: xxx Supervisor phone:

Please describe your duties as related to your desired adjunct instructional areas:

x

TEACHING EXPERIENCE

Desribe your teaching experience, especially as related to your desired adjunct instruction area in 30 words or less:

x

PUBLICATION HISTORY

Provide references to your scholarly publications in 30 words or less:

x

EXPERIENCE WITH MEDIATED INSTRUCTION

Desribe your experience using the world wide web and any other distance delivered instructional media in 30 words or less:

x

EXPERIENCE DELIVERING INSTRUCTION TO ADULT LEARNERS

Desribe your knowledge of and experience with the helping adult learners grow academically and professionally in 30 words or less:

x

OTHER RELATED SKILLS/EXPERIENCE

Desribe any other skills not mentioned above or provide other background information related to your ability to serve as an adjunct in your desired instructional area in 30 words or less:

x

REFERENCES

Please list three professional references not including the supervisors listed in the Employment History section.

1. Name: Flagged fieldxxx Phone - day contact: Flagged field

eMail address: Flagged field (if not available, enter "none")

Occupation and nature of association with you: Flagged field

2. Name: Flagged field xxx Phone - day contact: Flagged field

eMail address: Flagged field (if not available, enter "none")

Occupation and nature of association with you: Flagged field

3. Name: Flagged fieldxxx Phone - day contact: Flagged field

eMail address: Flagged field (if not available, enter "none")

Occupation and nature of association with you: Flagged field

x

SUBMISSION OF SUPPORTING DOCUMENTATION

I acknowledge that my application will not be complete and will not be considered for inclusion in the adjunct candidate pool until I have submitted:

Official transcripts from all academic institutions Flagged field
Copies of professional certifications and/or licensesFlagged field
My up-to-date curriculum vitae Flagged field

Send supporting documents (or request official copies to be sent) to: Outreach Services, Adjunct Instructor Candidate Pool Application, PO Box 790, University of Wisconsin-Stout, Menomonie, Wisconsin 54751.

x

OPTIONAL SEARCH RELATED INFORMATION

What led you to apply for the adjunct candidate pool?

Position Announcement xxxxxNewspaper Ad xxxxxWeb Site Posting

Word of Mouth – Friend/Relative xxxxxWord of Mouth – UW-Stout Employee

Electronic (eMail) message xxxxx Other (Please explain):

I have read the following statements and, by submitting this application agree to the conditions referenced: Flagged field

  1. I certify that the statements made by me in this application are true, complete and correct to the best of my knowledge and belief. I understand that any false statements, misrepresentations or omissions made by me during the application process shall be grounds for refusal to include my records in the adjunct candidate pool or to subsequently employ me in an adjunct or any other positions with University of Wisconsin-Stout, or, if employed, termination.
  2. I hereby authorize University of Wisconsin-Stout to investigate and verify, through whatever means deemed appropriate any information included in this application and all supporting documents that I submit to complete this application for inclusion in the adjunct candidate pool. University of Wisconsin-Stout is authorized to use any information obtained from its investigations to determine my suitability for inclusion in the adjunct candidate pool. I release University of Wisconsin-Stout from any liability in connection with the investigation.
  3. I hereby authorize each former employer and all persons given as references to answer any questions that may be asked.
  4. I hereby authorize each former employer to open my personnel file to a duly authorized representative of University of Wisconsin-Stout.
  5. I understand that nothing contained in this application or the possible inclusion of the application in the University of Wisconsin-Stout adjunct candidate pool is intended to create an employment contract between University of Wisconsin-Stout and myself for either employment or the providing of any benefit. Further, I understand that inclusion in the adjuct candidate pool does not convey any right to claim that I am officially serving the University in an adjunct capacity. Thus, I understand that I may not claim to be an adjunct with University of Wisconsin-Stout on any vita, resume, or other credential display system solely by the submission of this application or solely be inclusion of my records in the adjunct pool, nor will I represent myself as an adjunct instructor with University of Wisconsin-Stout to any other entity, including other universities, associations, and training organizations (both public and private.)
  6. I understand that submission of this application does not obligate University of Wisconsin-Stout in any way.
  7. If my information is included in the University of Wisconsin-Stout adjunct candidate pool, I understand my record will remain active for no longer than 12 months, but may be pulled from the pool by the University at any time and for any reason. After 12 months, I will be given the opportunity to update my application prior to reconsideration for continued inclusion in the candidate pool. Further, I understand that I may request that my record be pulled from the candidate pool at any time and for any reason.

Fields with a Red Flag Flagged field must be completed to submit your application.

 

UW-Stout | Outreach Services

Outreach Services
Adjunct Instructor Candidate Pool Application
PO Box 790
University of Wisconsin-Stout
Menomonie, Wisconsin 54751-0790

715-232-5270
715/232-3385 (fax)

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University of Wisconsin
All rights reserved.

Send questions and/or comments to:
bergesont@uwstout.edu