PO Box 556
Murfreesboro, TN 37132
Office (615) 898-2104
FAX (615)898-5568
Date of Application __________________________ Expected date of Graduation (mo/yr) ___________
Name (last)______________________________ (first)______________________ (middle initial)_______
Preferred Name ____________________________________ M Number M__________________________
Local Address________________________________ Apt #______ Cell Phone ______________________
City__________________________ State_______ Zip __________ Other Phone _____________________
Email Address _____________________@mtmail.mtsu.edu Other Email_____________________________
Person to notify in case of emergency:
Name__________________________________________________ Relationship to you________________
Address_________________________________________________ Phone __________________________
City________________________________________ State__________________ Zip________________
_____ Are you a recipient of MTSU Presidential or Service Scholarship (work 75 hours per semester)?
_____ Are you a participant of the Federal Work Study program?
POSITION DESIRED (Indicate position preference - 1 st
choice, 2 nd
choice, 3 rd
choice)
_____ Customer Service Office Attendant - customer relations, cashier, answering phones, campus errands, copying, filing, etc.
_____ Exercise Instructor - lead a variety of group fitness classes - land or water
_____ Intramural Event Assistant/Scorekeeper – marketing, scorekeeping, and office duties
_____ Intramural Official - c ircle all that you have experience w/: basketball, volleyball, softball, football, soccer
_____ Lifeguard/Water Safety Instructor - guard, teach, pool maintenance, record keeping, etc. American Red Cross certification
_____ Maintenance Assistant – perform fitness equipment/facility maintenance, repair, and clean-up.
_____ Marketing - create and communicate using social media, web site, blogging, print media, photography and video, etc.
_____ Mascot Attendant - assist mascot at all functions. Attend games, tournaments, nationals to aid and escort at functions.
_____ Outdoor Pursuits - challenge course, climbing wall, outdoor equipment rental, and adventure trip leader (will train for all)
** for this position, please include a 1 page essay on why you want to work in the Outdoors program
_____ Personal Fitness Trainer - certification preferred
_____ Rec Staff - customer relations, equipment check-out, answer phones, cashier, monitor fitness equipment & use
_____ Sports Clubs Supervisor - supervising or monitoring practices and games for approximately 25 club teams
CURRENT CERTIFICATIONS (check all that apply)
____ First Aid
____ CPR
Exp. Date _________
Exp. Date _________
____ AED Exp. Date _________
____ Exercise Instructor Exp. Date _________
Certified in: ________________________
WORK EXPERIENCE (past two years)
Employer ________________________________
Supervisor ________________________________
Phone (______)_________________________
Job Title ________________________________
Dates employed _____________to_____________
Duties ________________________________
____ Lifeguard
____ Water Safety Instructor
Exp. Date _________
Exp. Date _________
____ Lifeguard Instructor Exp. Date _________
____ Other ______________ Exp. Date _________
Employer ________________________________
Supervisor ________________________________
Phone ( ______ )________________________
Job Title ________________________________
Dates employed _____________to_____________
Duties ________________________________

Have you previously been employed by MTSU? _____ yes _____ no
In which department? ________________________ Supervisor ___________________________
Place an (x) in the spaces you are AVAILABLE to work.
TIME MON TUES WED THURS FRI SAT SUN
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Please check the Semester(s) Applying for: ___Fall 20___ ___Spring 20___ ___Summer 20___
Additional comments for schedule purposes only: __________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please list any skills, software knowledge, web design, or other experience:
__________________________________________________________________________________________
__________________________________________________________________________________________
Can you work during breaks, between semesters, and holidays? _____ yes _____ no
Have you ever been convicted of an offense other than minor traffic violations within the past five years?
_____ yes _____ no If yes, please explain:
I certify that such statements are true and understand that misrepresentation or omission of facts called for in this application may be cause for termination of employment without notice. I understand that work references may be contacted for verification of employment. I understand that evaluations of job performance will occur each semester and will affect continued employment. I understand that, if hired, I will be responsible to pay $17.50 to cover half the cost of American Red Cross certification or recertification.
Signature: _____________________________________________________ Date: ___________________________
THANKS FOR YOUR INTEREST IN MTSU CAMPUS RECREATION!
A Tennessee Board of Regents University
MTSU is an equal opportunity, non-racially identifiable, educational institution that does not discriminate against individuals with disabilities.
*********************************************************** Office Use Only **************************************************************
Date Application Received: ___________________ Date Acknowledged:________________________ updated 7/2013