Baylor College of Medicine


Assistant Professor

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Your Information

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Personal Information

Please use your formal, legal name as listed on your Social Security Card, Passport, or other legal documents. Please do not include titles (e.g. Mr. or Ms.), initials, or credentials (e.g. PhD, MD).

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Additional Information

Are you legally authorized to work in the U.S.?

What is the basis of your current work authorization?

Will you now or in the future require visa sponsorship for employment at Baylor College of Medicine?

Please describe your current or previous employment or affiliation with Baylor College of Medicine.

Do you have relatives employed at Baylor College of Medicine?  If yes, please list their name(s) and department.

Have you ever been suspended or discharged from any position excluding layoffs?  If yes, please explain.

Have you ever been convicted of any misdemeanor or felony offense other than a minor traffic violation?  If yes, please give nature, time, place and disposition of case.


NOTE: It is of vital importance that this question be answered truthfully in order to be considered for employment. Criminal offenses include felonies, misdemeanors, and summary offenses. Examples: Driving under the Influence, Possession of drugs, Fraudulent or Bad Checks, Disturbing the Peace, Leaving the Scene of an Accident, Robbery, etc.

A conviction itself does not constitute an automatic bar to employment. The seriousness of the crime, date of conviction, and relatedness to the job for which you are applying will be considered. Falsification or omission of information will affect your eligibility status as an applicant for this position and jeopardize your eligibility for future consideration.

Have you ever been sanctioned, disciplined, debarred, and/or excluded by a duly authorized regulatory agency or are there any current restrictions or limits on your license(s) or certifications(s)?  If yes, please include a complete explanation.

In the event that you are selected as a finalist for employment, a background check will be conducted. The information requested above will be required to expedite the background check process, should it occur. This information is needed to ensure that you are properly identified during the course of the background investigation.

 It is of vital importance that the information is completed accurately. This information is not made available to Hiring Managers during the selection process. A signed "Notice/Authorization and Release for the Procurement of a Consumer and/or Investigative Consumer Report Form" is also required as part of the Baylor College of Medicine background check process.

This information will not be accepted if altered or incomplete.

If you do not have a Social Security Number (SSN) at this time, please use 111-11-1111 in lieu of the SSN.

Resume and Questions

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Work and Education History

Education History

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Employment History

Please enter your last two (2) jobs starting with your present or last job, if possible, by clicking the Add Work History link. "See attached CV" will not be acceptable.

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Other History

Certificates and Licenses

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Review and Submit

I hereby certify that the facts provided pertaining to my employment at Baylor College of Medicine are true and complete to the best of my knowledge. I authorize an investigative consumer report of all statements contained in this application for employment which may be necessary in arriving at an employment decision. I understand that, if employed, any false statement on this application, receipt of unsatisfactory references, failure to complete the prescribed medical review, or failure to provide proof of legal employment status may result in termination of my employment. BY SIGNING BELOW, I certify that I have read and agree with these statements. I certify that I have read and agree with these statements and this represents my electronic signature.


Application Review