Student Assistant Employment Application

First Name

Last Name

Blugold ID

Local Address

Country

Street

City

Region

Postal Code

Phone Number

Email Address

Major

Number of credits earned to date

Expected graduation date

Please list a range of hours indicating the minimum and maximum number of hours you would like to work.

Select any terms you are able/willing to work:

Fall

Winterim

Spring

Summer

What is your computer ability?

High

Moderate

Low

Do you have federal work study allocation?

Yes

Amount of work study allocation per semester

Please list any work or educational experience that may apply to this position.

References

Reference #1

Full Name

Company

Relationship

Reference #2

Full Name

Company

Relationship

Previous Employment

Employment #1 (if applicable)

Company

Responsibilities

Start Date

End Date

Reason for Leaving

Employment #2 (if applicable)

Company

Responsibilities

Start Date

End Date

Reason for Leaving

Disclaimer and Signature

I authorize the Admissions Office to review my current transcripts as part of the application process for employment as an Admissions Student Assistant.

Signature

Date