Candidate Information and Selection Sheet

Human Resources
620 West Clairemont Avenue
Eau Claire, WI 54701

Please complete and return this form to indicate your interest in Part-Time and Substitute Teaching Assignments as they occur. Candidates applying via our web site will receive a memo to confirm the selections made. Thank you for your interest in CVTC.

*Note: Special characters are NOT allowed in the input fields*

Last Name:

First Name:

Middle Name/Initial:

Street Address:

City:

State:

Zip Code:

Phone - Home:

Business:

Email Address:

I currently hold or have held certification by the Wisconsin Technical College System (WTCS) in the following instructional area/areas:

(optional)

I am interested in teaching in the following instructional areas: (Please do not check more than 3 areas.)
Business Accounting Administrative Assistant Business Management CISCO Computer Software Courses Adobe Photoshop/ Dreamweaver Geographic Information Systems Instructional Assistant Insurance IT - Programmer/ Analyst IT - Network Specialist Marketing Medical Office Specialist Office Assistant Paralegal Quality Management Real Estate Records and Info. Management Supervisory Management Health AODA Central Supply Technician Clinical Lab Technician Phlebotomy Dental Assistant Dental Hygienist Diag. Medical Sonography Health Information Tech. Medical Administrative Technician Medical Assistant Medical Coding Specialist Medical Transcription Nursing - Associate Degree Nursing Assistant Pharmacy Technician Practical Nursing Radiography Renal Dialysis Respiratory Therapist Surgical Technologist Therapeutic Massage	Manufacturing & Agriculture Agriscience Technician Civil Engineering Electromechanical Technician Electronics Farm Business and Production Mgt Industrial Engineering Technician Industrial Mechanic Horticulture (Landscaping) Machine Tooling Technics (Micro-Machining) Nanoscience Technology Tool and Die Making Welding Mechanical Auto Collision Repair/ Refinish Tech. Automotive Maintenance Diesel/Heavy Equipment Tech. Electrical Power Distribution Electromechanical Technician Electrical Engineering Technology HVACR Service Technician Industrial Mechanic Motorcycle/Marine/ Outdoor Products Welding Personal & Consumer Barber-Cosmetologist Child Care Services Hotel and Restaurant Management	Public Safety Criminal Justice -Law Enforcement Criminal Justice-Law Enf. Academy Emerg Med Tech -Paramedic Adv. EMS Fire Protection Technician Group Dynamics Paramedic Technician Transportation & Construction Civil Engineering HVACR Designer/ Technician Motorcycle Safety Truck Driving Welding Wood Technics Other Apprenticeship Electrical Journeyworker General Education American Sign Language Basic Skills College Success English/Communication Skills English as a Second Language Mathematics Reading Natural Science Anatomy and Physiology Biology Chemistry Microbiology Physics Social Science Economics History Political Science Psychology Sociology Special Education / Exceptional Education Needs

List specific courses, such as: Medical Terminology, Coding, Access, Criminal Law, Drafting Schematics, First Responder, Networking, Economics, etc.

I am interested in:

Part-Time Instructor Positions
Substitute Instructor Positions

Employment Status:

New Applicant, never employed by CVTC
Employed by CVTC, but not as an instructor
Current Part-Time/Adjunct Instructor
Previously employed at CVTC

I am able to instruct at the following times:

Day Hours
Evening Hours
Weekend Hours

I am able to instruct at the following campuses:

Chippewa Falls
Eau Claire
Menomonie
Neillsville
River Falls
Other locations throughout the district.

I have previous experience in the following teaching methods:

Traditional Classroom
Accelerated Learning
Online Instruction
Other (please specify)

Years of work experience in my area of instruction:

Nature of work experience:

Education:

Vocational Diploma
     Major:
Associate of Applied Science Degree
     Major:
Bachelor's Degree
     Major:
     Minor:
Master's Degree
     Major:
     Minor:
Ph.D./Educational Specialist
     Major:
Juris Doctor

Thank you for your interest in teaching at Chippewa Valley Technical College.

Online users: Please verify that all information is accurate before you submit this form, then click the Submit button ONLY ONCE. A confirmation letter should appear in a few seconds.

Lori Boeck, HR Recruitment Team
Email : lboeck@cvtc.edu