Student Employment Application

Personal Information

Name:

Permanent/Home Contact Information

Home Address:

Home City:      State:

Zip Code:     Home Phone:

Local Contact Information

Local Address:

Local City:      State:

Zip Code:      Local Phone:

E-mail Address:

School Information

Major:

Minor:

Year in school:
Freshman          Sophomore          Junior          Senior

Pay: Are you eligible for Federal Workstudy?
Yes          No

If you have Federal Workstudy, how much each semester?
Fall:      Spring:      Summer:

Please list any physical limitations:

Work Experience in the last three years?

Most Recent Employer

Employer Name:

Employer Address:

City:

State:     Zip Code:

Type of Work:

Beginning Date:      Ending Date:

Other Previous Employer

Employer Name:

Employer Address:

City:

State:     Zip Code:

Type of Work:

Beginning Date:      Ending Date:

Other Previous Employer

Employer Name:

Employer Address:

City:

State:     Zip Code:

Type of Work:

Beginning Date:      Ending Date:

Questions:

Why would you like to work in the Children's Center?

Special talents you could give to the Childen's Center?

References

Reference #1

Name:

Address:

City:

State:     Zip Code:

Phone Number:

Occupation:

Reference #2

Name:

Address:

City:

State:     Zip Code:

Phone Number:

Occupation:

Reference #3

Name:

Address:

City:

State:     Zip Code:

Phone Number:

Occupation:

Today's Date: