Print Form
Office Use Only
Date of Application
Student Employment Application
University of Wisconsin-Stout Dining Services
Date of Hire
Fall Semester
General Information:
Job Title
Employment Information:
Name________________________________
Student ID Number
E-mail Address_________________________
Local Address_________________________
_____________________________________
Local/Cell Phone # ________________________
Permanent Address______________________
_____________________________________
Permanent Phone # ______________________
Available starting date___________________
Position(s) applying for_______________________
__________________________________________
__________________________________________
How many hours would you prefer to work
during the week (Mon-Fri)?___________________
Do you want a weekend shift? Yes
or No
Which facility(s) are you applying for?
Memorial Student Center (south campus)
Merle Price Commons (south campus)
North Point Dining Hall (north campus)
Catering/Bartending (south campus)
Class & Commitment Schedule:
Place an “x” where you have commitments. All commitments must be marked including but not limited
to: sports, clubs, organizations, committees, class, worship/prayer, etc. If these are not on application and
interfere with an accepted shift, that shift will be removed from the student's schedule. Check with department for
specific hours of operation, as some weekend hours may be required.
Period
Hours
6:00-7:00
1
2
3
4
7:00-8:00
8:00-9:05
9:05-10:10
10:10-11:15
11:15-12:20
5
6
7
8
9
10
12:20-1:25
1:25-2:30
2:30-3:35
3:35-4:40
4:40-5:45
5:45-6:45
11
12
13
14
15
6:45-7:45
7:45-8:45
8:45-9:50
9:50-10:55
11:00-12:00
Monday
Tuesday
Wednesday
Thursday
Friday
Look for employment opportunities on the Internet:
www.uwstout.edu/dining
Saturday
Sunday
Name: ______________________________
Financial Aid Eligibility:
Work Study
Special Skills/Certifications:
$________________
State Payroll
Unsure
Have you worked on campus before?_________
Describe any special skills, certifications, training,
coursework, major related to job, etc. (i.e. typing,
computer experience, CPR certification, lifeguard.)
________________________________________
________________________________________
________________________________________
Certifications:
______________________Expires:___________
______________________Expires:___________
Positive Actions – Enter date of positive action and initial entry (Office Use Only)
Work and Other Experience History (Begin with most recent position):
Dates of Employment
(include current and previous
UW-Stout positions.)
Place of Employment
(contact name, address, and phone #)
References (Former Employers, Faculty, or Staff):
Name
Phone Number
Position/Duties/Responsibilities
Position
All of the information on this application is true and complete to the best of my knowledge, and I authorize
investigation of all statements contained in this application. The information may be used to reach a decision
about employment.
Applicant’s Signature_______________________________ Date_________________
The University of Wisconsin-Stout is an Equal Opportunity/Affirmative Action institution committed to
Diversity in its people and programs.
Please drop off at desired location or return a completed application to:
Commons/North Point
Student Center/Catering
University Dining Service
Jan Rasmussen- Price Commons
1110 S. Broadway Rm. 224
Menomonie, WI 54751
University Dining Service
224 Memorial Student Center
Menomonie, WI 54751