All applications must be completed using 12 point font.
Handwritten applications will not be accepted.
Resumes must be attached to applications.
Send completed applications and resumes to elcassetto@lcsc.edu
LCSC Work Scholars provides the opportunity for students to acquire professional skills and gain workforce experience while offsetting the need to rely on student loans, reducing tuition costs, and offering a pathway to
APPLICANT INFORMATION employment after graduation.
Name: ____________________________________________________
Address: __________________________________________________
City: __________________ State: ________________ Zip: ________________
Phone: ________________ LCSC E-mail: ________________________________________________
ID Number: ______________ Major: ______________________ Enrollment Status: Full-time Part-time
Number of college credits earned to date: ____________ Current cumulative GPA: __________
Military Service (Complete if you have served in the Armed Forces)
Branch of Service ________________________
Dates of Service: From ____________________ To __________________________

Motivation - Please limit response for each question to 500 words or fewer. Attach a separate page if necessary.
Explain your reasons for wishing to be a member of the Work Scholars program.
What do you hope to learn from your employment?
Describe the type of work desired and why.
Explain what you have to offer a potential employer.
Indicate days and hours you expect to be available for work (minimum 10 hours per week during academic year).

Skills and Experience
Indicate the specific work skills you possess and how you acquired those skills (check all that apply). This information will allow us to assess job placement options and training needs.
Customer Service _____ Basic Computer _____ Accounting _____
Public Speaking _____ Childcare _____
Microsoft:
Word _____ Excel _____
PowerPoint _____ Outlook ____
Access _____ Publisher _____
Other software _____
Oral Communication ______
Computer Skills:
Troubleshooting _____
Web Development/Design _____
Written Communication ______
Retail _____
Office Skills
Telephone _____ Copy/Fax ____
Keyboarding _____ wpm____
Filing _____
Shop Safety Procedures _____
Electrical System Repairs _____ Basic Engine Diagnostics _____
Equipment Safety Inspections ____ Teamwork _____
Workplace Safety _____ Safe and Appropriate Use of Tools _____
Parts Inventory Maintenance ____
Time Management _____
Other: _____

Provide the following information for current and previous employers. Please include a copy of your current resume.
Name of Employer: __________________________________________________________________________
Employer Address: __________________________________________________________________________
Supervisor Name: ___________________________________________________________________________
Employed From (MM/DD/YY)______________________ To (MM/DD/YY) ______________________________
Job Duties: ________________________________________________________________________________
__________________________________________________________________________________________
May we contact this employer? Yes ______ No ______
Name of Employer: __________________________________________________________________________
Employer Address: __________________________________________________________________________
Supervisor Name: ___________________________________________________________________________
Employed From (MM/DD/YY)______________________ To (MM/DD/YY) ______________________________
Job Duties: ________________________________________________________________________________
__________________________________________________________________________________________
May we contact this employer? Yes ______ No ______
Name of Employer: __________________________________________________________________________
Employer Address: __________________________________________________________________________
Supervisor Name: ___________________________________________________________________________
Employed From (MM/DD/YY)______________________ To (MM/DD/YY) ______________________________
Job Duties: ________________________________________________________________________________
__________________________________________________________________________________________

May we contact this employer? Yes ______ No ______
If you need space for additional employers, please attach separate sheet with the required information.
Acknowledgement
The information I have provided in this application for Work Scholars is true, correct and complete. False, incomplete, or misrepresented information of any kind, will be sufficient cause for my application to be rejected, or, if discovered after I am employed, cause for immediate termination of my employment. This application is not an employment agreement. I understand that if accepted as a Work Scholar I agree to abide by all program and College policies and procedures or changes therein.
All Work Scholars are subject to the successful completion of a criminal background check.
Signature: _____________________________________________
Date: _________________________