UNI Academic Learning Center
Math and Science Services
Application for Employment
This application must be accompanied by your résumé, three references (including name, title, and complete contact information) and
college transcript/grade report. An unofficial transcript is acceptable.
(Please type or use ink and print legibly using capital letters)
Last Name:
First Name:
Address:
City:
Home Phone:
Position Applying for:
Middle Name:
State:
Cell Phone:
Zip:
E-mail Address:
 Mathematics Tutor
 Science Tutor
Have you ever filed an application with us before? _____ Yes ____ No
If yes, give date:_______________________________
Have you ever been employed on campus before?
_____ Yes ____ No If yes, department: ____________________________
When will you graduate from UNI?_______________________________________________________________________________
Are you able to be lawfully employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration
status will be required upon employment.) ______Yes _____No
Have you, since the age of 18, ever been convicted of a crime other than a minor traffic offense? (A conviction generally does not
disqualify you from consideration for employment.)
Yes
No
If yes, please explain: _________________________________________________________________________________________
EDUCATION
High School
College/University
Graduate/Professional
9 10 11 12
1 2 3 4
1 2 3 4
School Name & Location
Highest Year Completed
Diploma/Degree(s)
Describe Course of Study
List mathematics and science courses taken at the University of Northern Iowa. Indicate grades earned.
List mathematics and sciences courses taken outside of UNI. Indicate grades earned.
Applicant Statement: I certify answers given herein are true and complete to the best of my knowledge. I authorize investigation
of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the
event of employment, I understand that false or misleading information given in my application or interview(s) may result in
discharge. I understand I am required to abide by all rules and regulations of the employer. If hired, I understand that I must verify
my eligibility for employment with UNI Student Employment.
Signature of Applicant:
Date:
Return completed applications to: Academic Learning Center—ITTC 008 or via email at unialcmsonline@uni.edu.
The University of Northern Iowa is an equal opportunity employer with a comprehensive plan for affirmative action.
Revised 5/23/14 LH