Entered System on: Monday, December 14, 2015 |
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MY APPLICATION ON THE CCC REGISTRY
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PERSONAL INFORMATION
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Last Name:
Benfell
First Name:
David
Middle Initial:
A |
Other Name(s) Used:
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Street Address:
321 S. Main St. #12
City:
Sebastopol
State:
CA
Zip:
95472 |
Telephone (Day):
Telephone (Evening):
707-824-1194
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Telephone (Cell):
707-824-1194
Email:
benfell@n4rky.me
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EDUCATION
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List in reverse chronological order
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(1) Name of Institution:
Saybrook University |
Location (City/State):
475 14th Street, 9th Floor, Oakland, CA 94612 |
Diploma/Degree Received:
EdS/EdD/PhD |
Major:
Human Science |
Total Units Completed Semester:
65
Quarter:
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(2) Name of Institution:
CSU East Bay |
Location (City/State):
25800 Carlos Bee Boulevard, Hayward, CA 94542 |
Diploma/Degree Received
MA/MS/MED/MBA/MFA |
Major:
Speech Communication |
Total Units Completed Semester:
Quarter:
106 |
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(3) Name of Institution:
CSU East Bay |
Location (City/State):
25800 Carlos Bee Boulevard, Hayward, CA 94542 |
Diploma/Degree Received:
BA/BS |
Major:
Mass Communication |
Total Units Completed Semester:
Quarter:
243 |
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(4) Name of Institution:
American River College |
Location (City/State):
4700 College Oak Drive, Sacramento, Calif. 95841 |
Diploma/Degree Received:
AA/AS |
Major:
Business Data Processing |
Total Units Completed Semester:
Quarter:
91.5 |
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CALIFORNIA COMMUNITY COLLEGE CREDENTIALS |
(1) Type of Credential:
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Authorized Subjects:
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Expiration Date:
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(2) Type of Credential:
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Authorized Subjects:
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Expiration Date:
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OTHER PROFESSIONAL CREDENTIALS, CERTIFICATES AND LICENSES
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(1) Type Presently Held:
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ID Number:
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Expiration Date:
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(2) Type Presently Held:
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ID Number:
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Expiration Date:
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EMPLOYMENT HISTORY
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List your occupational experience for the last 15 years, listing most recent employment
first. Provide your complete employment history even if you attach a resume.
If you had more than one position with the same employer, list each position separately.
If more space is needed, continue on a blank sheet of paper using the same format.
Please explain gaps in employment.
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(1) Employer:
CSU East Bay |
Supervisor:
Isaac Catt |
Address:
25800 Carlos Bee Boulevard, Hayward, CA 94542 |
Position:
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Title:
Teaching Associate |
Employment Dates: From
6/1/2007
To
6/30/2009 |
Full-Time/Part-Time:
Part-Time |
Phone:
510-885-3292 |
Duties or Subjects Taught:
public speaking |
If instructional position, number of credits taught/year:
20 |
Quarter |
Reason for leaving:
This was a graduate student position that ended with graduation |
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(2) Employer:
CSU East Bay |
Supervisor:
Deborah Alexander |
Address:
25800 Carlos Bee Boulevard, Hayward, CA 94542 |
Position:
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Title:
Lab Assistant |
Employment Dates: From
4/1/2007
To
6/30/2008 |
Full-Time/Part-Time:
Part-Time |
Phone:
510-885-3292 |
Duties or Subjects Taught:
supervised communications lab and tutored students |
If instructional position, number of credits taught/year:
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Reason for leaving:
At the time, gas costs were skyrocketing, and the schedule meant I had to commute 40 miles each way on extra days to school |
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(3) Employer:
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Supervisor:
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Address:
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Position:
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Title:
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Employment Dates: From
To
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Full-Time/Part-Time:
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Phone:
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Duties or Subjects Taught:
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If instructional position, number of credits taught/year:
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Reason for leaving:
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(4) Employer:
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Supervisor:
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Address:
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Position:
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Title:
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Employment Dates: From
To
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Full-Time/Part-Time:
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Phone:
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Duties or Subjects Taught:
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If instructional position, number of credits taught/year:
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Reason for leaving:
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During the selection process, we may conduct reference checks with employers
and supervisors listed above as well as others. If you do not want a certain employer
or supervisor contacted initially, indicate who and why. |
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PROFESSIONAL REFERENCES |
List persons who can critically assess your work qualifications and job performance.
This is not a substitute for required reference letters.
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(1) Name:
Robert McAndrews |
Position:
Professor |
Company/Organization:
Saybrook University |
Address:
475 14th Street, 9th Floor |
Telephone:
719-651-5089 |
Email:
rmcandr000@aol.com |
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(2) Name:
JoAnn McAllister |
Position:
President |
Company/Organization:
Human Science Institute |
Address:
525 West Lawrence |
Telephone:
415-627-8456 |
Email:
jmc304@live.com |
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(3) Name:
Marc Pilisuk |
Position:
Professor |
Company/Organization:
Saybrook University |
Address:
494 Cragmont Ave. |
Telephone:
510-526-9876 |
Email:
mpilisuk@saybrook.edu |
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(4) Name:
Richard Giovannoli |
Position:
Psychologist |
Company/Organization:
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Address:
874 Gravenstein Hwy South, Suite 12 |
Telephone:
707-824-8834 |
Email:
rgiovan@sonic.net |
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PROFESSIONAL TRADE, BUSINESS, OR CIVIC ACTIVITIES AND OFFICES HELD
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You may exclude those, which indicate race, color, religion, national origin, veteran
status, ancestry, sex, sexual orientation, age, or disability.
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(1) Organization:
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Activities:
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(2) Organization:
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Activities:
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(3) Organization:
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Activities:
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(4) Organization:
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Activities:
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DIVERSITY STATEMENT |
In the space below, provide a statement about yourself that specifically demonstrates
sensitivity to and understanding of the diverse academic, socioeconomic, cultural,
and ethnic backgrounds of community college staff and students and to staff and
students with disabilities.
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At CSU East Bay, I taught students from diverse backgrounds. My recently completed dissertation work employed a critical theory methodology on conservative attitudes toward undocumented migration. |
CERTIFICATION AND AGREEMENT OF APPLICANT |
Please read carefully before signing
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This application and all supporting documents become the property of the Community
College District to which I have applied and will not be returned.
Certification: I hereby certify that all statements made on this application
and any attachments are true and complete to the best of my knowledge. I understand
that any false, incomplete or incorrect statement may result in my dismissal from
employment with the Community College District to which I have applied.
I authorize the District to investigate my references, work record, education, performance
evaluations or any other matters relating to my suitability for employment. I authorize
and direct my former or current employers and educational institutions to release
to the District any information they may have concerning my employment or education.
I also authorize the District to obtain and review any documents or records, including
driving records, which are applicable to my employment. I release the parties listed
above from any and all liability related to this process of supplying or gathering
any information about my suitability for employment.
I also understand that an incomplete application may delay or prevent employment
opportunities with the College(s). I hereby release the Colleges checked on page
1, as well as those contacted by the College(s) from any liability or damage which
may result from providing or using the information requested.
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Signature:
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