Apply for Self Mentor - CSUDH Toro Auxiliary Partners

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:	Self Mentor
ID:	1370
Department:	Administrative
Type of Appointment:	Temporary
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Resume:	Supported formats: Word, PDF, RTF, Text, and HTML.

	- or Upload from:


Cover Letter:	You can type in a Cover Letter or Copy/Paste from an existing document.
* Resume:

	- or Upload from:



Cover Letter:

	- or Upload from:



* Unofficial transcript:

	- or Upload from:

CSUDH TAP Application - new

PERSONAL INFORMATION

* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment):

Yes No

* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):

Yes No

* Have you ever worked for the CSUDH Toro Auxiliary Partners (Foundation) before?:

Yes No

* Do you have any relatives or friends employed by the CSUDH Toro Auxiliary Partners?:

Yes No

If yes, please provide full name of any relatives or friends.:

* Have you ever been discharged or forced to resign from any position because of misconduct or unsatisfactory performance?:

Yes No

If Yes, please provide details (When/Job Title/Department).:

* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?:

Yes No

If no, please explain. *The Toro Auxiliary Partners complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.:

EMPLOYMENT DESIRED

* When would you be available to begin work?:

* Type of employment desired:

Full Time
Part Time
Seasonal

* Hourly rate/salary desired:

* Are you currently employed?:

Yes No

* If so may we inquire of your present employer?:

Yes No

If presently employed, why are you considering leaving?:

EDUCATION

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location	Did you Graduate?	Degree Received	Subjects Studied/Major
*	* Yes No	*	*
	Yes No
	Yes No

If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:

EMPLOYMENT HISTORY

Give your full employment record, starting with your current or most recent employment

EMPLOYER 1

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
Yes No
Responsibilities	Reason for Leaving

EMPLOYER 2

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
Yes No
Responsibilities	Reason for Leaving

EMPLOYER 3

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
Yes No
Responsibilities	Reason for Leaving

REFERENCES Please provide three references (not relatives).

Name	Relationship	Phone Number
*	*	*
*	*	*
*	*	*

AUTHORIZATION

The facts set forth in this application and any supplemental information are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If I am hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.

* Signature (type name)::

* Date:

CSUDH Foundation Vaccination Policy

The CSUDH campus requires all employees to be vaccinated in order to work on campus. As such, vaccination or medical/religious exemptions are required. Proof of vaccination or medical/religious exemption will be required as a condition of employment.

* Do you understand that you are required to provide proof of vaccination status or medical/religious exemption during the screening process in accordance with CSU policy?

	Yes
	No

California Resident

At this time CSUDH Foundation is only permitted to hire residents of the State of California.

* Are you a resident of California?

	Yes
	No

Application Source

* How did you hear about this position?

Voluntary Self-Identification of Disability CC-305

Voluntary Self-Identification of Disability

Form CC-305
Page 1 of 1

OMB Control Number 1250-0005
Expires 04/30/2026

Name:

Employee ID:

(if applicable)

Date:

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.

Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your "major life activities." If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or serious difficulty hearing
Diabetes

Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
Intellectual or developmental disability
Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports

Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
Partial or complete paralysis (any cause)
Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism)
Traumatic brain injury

Please check one of the boxes below:

Yes, I have a disability, or have had one in the past
No, I do not have a disability and have not had one in the past
I do not want to answer

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

For Employer Use Only

Employers may modify this section of the form as needed for recordkeeping purposes.

For example:

Job Title:

Date of Hire:

VEVRAA Pre-Offer Self-Identification Form

Invitation to Self-Identify

VETERANS

This company is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:

A "disabled veteran" is one of the following:
- A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
- A person who was discharged or released from active duty because of a service-connected disability.
A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Protected veterans may have additional rights under USERRA - the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

I identify as one or more of the classifications of Protected Veteran listed above.
I am not a Protected Veteran

Submit

Cancel

	American Indian or Alaska Native (Not Hispanic or Latino) A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
	Black or African American (Not Hispanic or Latino) A person having origins in any of the Black racial groups of Africa
	Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
	Asian (Not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
	White (Not Hispanic or Latino) A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
	Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
	Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above races
	I Choose Not to Respond

	Protected Veteran
	I Choose Not to Respond
	Individual with a Disability An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
	I Choose Not to Respond