Student Application

Name:

Phone:

Date:

E-mail Address:

Current Address:

Permanent Address:

Campus

	CSB
	SJU

Have you been granted a Work Study award?

	Yes
	No

Amount Expected (Award Total): $

Position Applying For:

Lab Assistant

Can you work the specified number of hours a week as the job requires?

	Yes
	No

Are you willing to work nights and weekends?

	Yes
	No

Past Work Experience (Both on-campus and off-campus employment):

Date Employed: From:

To:

Company Name:

Location (Address):

Job Title:

Supervisor:

Job Description:

Date Employed: From:

To:

Company Name:

Location (Address):

Job Title:

Supervisor:

Job Description:

References

Name:

Address:

City/State:

Phone:

Name:

Address:

Phone:

City/State:

Please describe any computer-related work experience you may have had:

Please describe what customer service experience you have:

Please describe any related courses or work experience that you may have had in business, accounting, statistics, or electronics:

Special skills, special interests, hobbies, other activities:

Important

Please describe why you feel you should be employed in the position you chose and why we should consider you for that position:

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