Office Host
Re si d e n ce D i r e ct o r
Night Host
Night Host
Re s id e n t As s is tan t
S WA R M
[1]
Name
Student ID #
Wi n t h r o p
Winthrop PO Box
or local address
Date Submitted
Permanent address
University
Applications will be kept on file for one academic year
Campus/Local Phone
Cell Phone
E-mail address
Academic Status:
Classifcation
Fresh. Soph. Jr. Sr. Grad.
Major
Minor
# of semesters attended at Winthrop
# of total hours earned
# of hours completed last semester
GPA
Cumulative GPA
# of hours currently enrolled
Anticipated graduation date:
Availability
[Shift hours are 11:00 PM - 7:00 AM]
Please circle the nights you are available to work:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Please circle if you may be called for emergencies:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What is your first date of availability?
Do you qualify for work-study?
YES
NO
If hired, each applicant is required to submit a criminal background check from his or her hometown police
department.If you do not fully disclose infromaton about your criminal convition history, you will not be
hired. NOTE: Omit minor vehicle violations and any offense committed before your 17th birthday, which was
finally adjudicated in juvenile court or under a youthful offender law. Conviction of a criminal offense is not a
bar to employment in all cases. Each conviction is evaluated individually.
Have you ever been convicted of any offense other than a minor traffic offense?
If YES, please explain on a separate sheet of paper and attach it to this application.
YES
NO
Have you had or do you currently have any Winthrop University Judicial or Residence Life
disciplinary sanctions against you?
If YES, please explain on a separate sheet of paper and attach it to this application.
YES
NO
opportunity
Division of Student Life
Winthrop University
Office Host
Re si d e n ce D i r e ct o r
Night Host
Employment Record
*
Employer
Night Host
Re s id e n t As s is tan t
S WA RM
[2]
List any previous employment, beginning with the most recent.
Dates
(from)
(to)
Address
Position Held
Phone #
Immediate Supervisor(s)
Can they be called as a reference?
Reason(s) for leaving
*
Employer
Dates
(from)
(to)
Address
Position Held
Phone #
Immediate Supervisor(s)
Can they be called as a reference?
Reason(s) for leaving
*
Employer
Dates
(from)
(to)
Address
Position Held
Phone #
Immediate Supervisor(s)
Can they be called as a reference?
Reason(s) for leaving
Involvement
Please list any organizations, clubs, groups, or community service you have been involved with while attending Winthrop
University, or during your senior year of high school (freshmen applicants only).
name
dates
position(s) held, awards
1.
2.
3.
cont’d...
Division of Student Life
Winthrop University
Office Host
Re si d e n ce D i r e ct o r
Night Host
References
Night Host
Re s id e n t As s is tan t
S WA R M
[3]
Please list at least three references. For example: professors, teachers, counselors, RAs, RLC/RDs, or other
employers. Please do not put friends or acquaintances as references.
name
title
phone #
1.
2.
3.
Certification of Application
I agree that all statements in this application are, to the best of my ability, true and correct. I authorize Winthrop
University to conduct necessary investigations to confirm statements on this application. If it is determined that any
untrue or misleading statement was made, I accept this as grounds for rejection or dismissal. I also authorize and
request each former employer, person, firm, or corporation given as a reference to answer any and all questions that
may be asked and to give any and all information that may be sought in connection with this application. I understand
that information about my work habits, character, skill, and reliability will be used in deciding whether or not I am
hired.
signature
signature
Division of Student Life
date
date
Winthrop University