SUMMER HOUSING ASSISTANT
- Application PERSONAL DATA
Name: _________________________________________________
Student No.: J00________________________
Preferred Name: _________________________________________
Soc. Sec. No. ___________________________
Date of Birth: ______/______/_________
Preferred Phone No. (_____) ______________
Number where you can be most easily reached
Residence Hall Address and Room # (if applicable) _______________
University E-Mail Address** _______________________________
Permanent Address ________________________________________________________________________________
**Note: University e-mail address will be the primary method of communication**
EMPLOYMENT
Please list paid work experience including part-time positions in reverse chronological order beginning with your most
recent position (Attached resumes with your application are encouraged but not required)
Begin / End Dates
Employer / Address
Title / Position
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Are you currently employed at the most recent position listed?

Yes
No
# of hrs. per week: _________
If selected as a SHA, will you be willing to terminate any other position you may hold?
Yes
No
If No, Why Not? _________________________________________________________
EDUCATION
Present Classification:
Freshman
Sophomore
Major: _______________________________________
Junior
Graduate
Minor: (if applicable) _____________________________
Overall Grade Point Average (GPA) _________
SHORT ANSWER – Please answer in the space provided (Please type or print legibly)
1. What does Customer Service mean to you?
Senior
2. How have you demonstrated dependability and flexibility in previous positions?
3. If you were selected, how would you keep your energy level high throughout the summer?
REFERENCES
Please provide two (2) references (non-relatives), understanding these individuals may be contacted by a professional
member of the Residence Life Team (Professors, staff members, current/past Resident Assistants, etc.)
Name
Position/Company
Telephone #
Nature of Relationship
Note: The University of South Alabama may, as part of its employment process, obtain a consumer report (i.e. employment verification, education
verification, criminal history, motor vehicle report, or credit history) on you and that your employment will depend on the satisfactory outcome of
this investigation.
I, the undersigned, have read the Conference Assistant position description and verify that I meet all the “Position
Qualifications & Requirements”.
Applicant’s Signature: _____________________________________________
Date: _____________________
--------------------------------------------------------------------------------------------------------------------------------------------------Please submit this form by e-mail to Amanda Freyaldenhoven afreyaldenhoven@southalabama.edu
or print and drop off at the Central Housing Office, Rm 100 Delta Commons
Amanda Freyaldenhoven
Assistant Director of Housing
Housing & Dining - University of South Alabama
afreyaldenhoven@southalabama.edu
For additional questions or comments please contact Amanda Freyaldenhoven by email or phone at (251) 460-7584
Thank you for your interest in Housing & Dining at the University of South Alabama. Go Jags!
UNIVERSITY OF SOUTH ALABAMA
BACKGROUND INVESTIGATION
PROSPECTIVE EMPLOYEE AGREEMENT
I,________________________________________________________________________________________,
First
Middle
Last
(*Social Security No. ________ - _____ - ________), understand that the University of South Alabama may, as
part of its employment process, obtain a consumer report (i.e. employment verification, education verification,
criminal history, government sanctioning, debarment, or exclusion, motor vehicle report, or credit history) on
me and that my employment will depend on the satisfactory outcome of this investigation. I understand that I
have the right to request disclosure of the nature, scope, and results of the investigation from:
National Application Processing & Screening, Inc.
P.O. Box 590
Bessemer, AL 35021
(205) 425-6277
I further understand that if any potentially adverse action is taken, based in whole or in part on the information
contained in this report, the University will provide a copy of this report to me.
You
are
are not (check one) authorized to check references with my current employer.
__________________________________________
Permanent Address
____________________________
*Date of Birth
__________________________________________
City, State, Zip
____________________________
County
__________________________________________
Signature
____________________________
Date
* Disclosure of Social Security Number and Date of Birth is not required by any statute of law and is voluntary on
your part. This information will be used to establish positive identity only. Failure to disclose your Social
Security Number or Date of Birth will not, in any way, affect your status as an applicant.
The University of South Alabama is an Equal Opportunity Employer. We do not discriminate on the basis of race, color,
age, religion, sex, national origin, disability, disabled veteran, or Vietnam-Era status.