CHEMISTRY DEPARTMENT
EMPLOYMENT APPLICATION FORM
STUDENT #:
DATE
NAME (PRINT):_____________________________________________________________
Last
First
Initial
LOCAL ADDRESS:
Street
City
State
Zip
Street
)
City
State
Zip
LOCAL PHONE:
HOME ADDRESS:
HOME PHONE: (
CLASS STANDING:
FRESH.
MAJOR:
MINOR:
SOPH.
JR.
G.P.A.
SR.
(OVERALL)
EXPECTED GRADUATION DATE:
Please number the jobs in the order of preference.(1=Highest)
(Example: The box numbered 1 will be the job you desire most.)
Dispensing Stockroom Receptionist
Office Aide
Laboratory Prep Trainee/Assistant
Secretarial Trainee/Asst.
Microcomputer Lab Assistant
Laboratory Teaching Asst.
Purchasing Trainee Assistant
Approximately how many hrs/wk would you like to work?______________________
Are you work study approved?
If yes, how much?
How did you hear about these jobs?
WORK HISTORY:
Employer
Duties/responsibilities
Dates worked
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
(Please complete the back of this form)
Computer Courses or Chemistry Courses You Have Taken
(indicate the college if not EMU):
Course #
Grade
Sem/Yr
Instructor
Course #
Can you type?________ If yes, list WPM________
Computer experience: ______IBM
______MacIntosh
Grade
Sem/Yr
Instructor
_____Windows
Indicate your schedule for the _______Semester. Show your classes by Department and
course number (example: CHM 371). Write a "w" in those times when you will be
available for work.
Hours
8:00
Monday
Tuesday
Wednesday
Thursday
9:00
10:00
11:00
12:00
1:00
2:00
3:00
4:00
5:00
6:30-9:30
DO NOT WRITE BELOW THIS LINE
--------------------------------------------------------------------------Interviewed: __________
W - 4 Card Recv'd: ________
CWS Card Recv'd:________
1st day: _________
Wage: ______
Last day: _________
Auth. Hrs: _______
P-36 no. ___________
disk: Word 6.0
doc:emplappII
Friday