Human Resources Department Room 139, Wyoming Hall Dept. 3422 1000 E. University Ave. Laramie, Wyoming 82071 Phone: (307) 766-2215 Fax: (307) 766-5607 TDD: (307) 766-2216 http://www.uwyo.edu/hr The University of Wyoming Application for Student Employment The University of Wyoming is an Equal Opportunity Affirmative Action Employer Name: (Print) (Last) Address Are you a U.S. Citizen? (First) Yes No (Middle) Telephone Number E-mail Address If "NO" Visa Class F-1 H-1 Have you ever been convicted of or pled guilty or nolo contendere/no contest to any felony? J-1 Yes No If yes, please explain: If the answer above is yes, you must provide a certified copy of conviction and any other pertinent, clarifying documents to the Human Resource Department. Have you ever been convicted of or pled guilty or nolo contendere/no contest to a sex Yes No crime against a minor or a sex crime involving violence? If yes, please explain: If the answer above is yes, you must provide a certified copy of conviction and any other pertinent, clarifying documents to the Human Resource Department. Date Available for Employment Number of Hours Work Desired Per Week Current UW Employee? Yes No If Yes Where? Do you have a current work-study award? Year in School Hours Enrolled Major Minor Graduate Classes Undergraduate Classes Hours Available for Work Skills/Licensure (Please check if proficient/trained in) Monday Typing (wpm) Calculator Custodial Tuesday Computer Cashier Foreign Language Wednesday Word Bookkeeping/Acct. Valid Driver's License Processing Thursday Spreadsheet Phone/Reception OTHER Friday Database Sales Saturday Data Entry Food Service Sunday Graphics Library List your employers, starting with your current or most recent employer. Please indicate any previous UW employment. It may be helpful to attach a resume. HOWEVER THE WORK EXPERIENCE SECTION IS REQUIRED EVEN THOUGH A RESUME MAY BE ATTACHED. You may also include volunteer experience. Current/Last Employer: Dates Worked: City/State: Reason for Leaving: Position Title: Major Duties/Activities: Employer: City/State: Position Title: Major Duties/Activities: Dates Worked: Reason for Leaving: I certify that all information given on this application, supporting documents, and interviews are correct to the best of my knowledge. I understand that giving false information may disqualify my application or result in termination. I understand that this application is not intended to be a contract of employment. I authorize the university to investigate all statements made on my application for employment. I authorize such educational institutions and employers and others (and their agents or employees) to respond to questions concerning information given on this application and I further release from liability the University of Wyoming, such former employers, institutions, or persons providing such information. I understand that no salary rate is final until approved by the Human Resources Department. Federal law requires employers to document the identity and employment authorization of each new employee. Signature: Date: If you are a person with a disability and need an accommodation for the application/interview process, please call 307-766-2215. Updated 07/25/07