rev. 10/08
page 1 of 2
Student Employment Application
The Carver Resource Center
The University of Toledo
Judith Herb College of Education
PRINT OR TYPE. Attach additional sheets, and/or resumé
Position: Student Assistant
PERSONAL DATA
Name: ___________________________________________________________
Last
First
Student ID #: _______ - ____ - _______
______________
MI
Date
UT Email Address: _________________________@utoledo.edu
NOTE: You MUST use the email address provided to you by UT (e.g., “john.smith@utoledo.edu”). If you wish to use a
different email address, YOU MUST have your UT email address forwarded to that address IMMEDIATELY.
Mailing Address:
Phone:
______________________________________________________________________________________
______________________________________________________________________________________
___________________________
Are you legally authorized or permitted to work in the United States?
Are you 18 years of age or older?
Yes _____ No _____
If no, explain.
Yes _____ No _____
Have you ever been convicted of a crime? (A conviction will not be an absolute bar to an offer of employment.)
Yes _____ No _____
If yes, explain.
PLACEMENT INFORMATION
How many hours per week do you wish to work (max. = 20)? _______
Have you ever been employed at The University of Toledo before?
If yes, explain.
What is your major?
_______________________________
What is your anticipated date of graduation?
Yes _____ No _____
What degree will you earn?
__________________
_______________
When is the last semester you would be available to work in the LTSC? Semester: ____________
Year: _________
Please describe what you consider to be your most outstanding skills or personal qualities.
_______________________________________________________________________________________
_______________________________________________________________________________________
What specific computer-related skills (both hardware and software) do you possess?
_______________________________________________________________________________________
_______________________________________________________________________________________
On a scale of 1-10 (10 is highest), rate your skill using: a Windows PC: __ a Macintosh: __
EDUCATION (list most recent at the top):
Name/Location of School
UT_______________________________________
__________________________________________
the Internet: __
Major/minor
__________________________________
__________________________________
Degree
_____________
_____________
GPA
_____
_____
List anything else that you feel is relevant to this position (e.g., work experience, honors, offices held, awards, activities, etc.).
Student Application for Employment
The Carver Resource Center (CRC)
rev. 10/08
page 2 of 2
EMPLOYMENT HISTORY
List most recent at the top.
Employer: _______________________________________________ Supervisor: ______________________________________
Address: ____________________________________________________________________________
Phone #: ______________________
Position: _______________________ Dates employed: from ________ to __________
Summary of your duties: _____________________________________________________________________________________
Reason for leaving: _________________________________________________________________________________________
Employer: _______________________________________________ Supervisor: ______________________________________
Address: ____________________________________________________________________________
Phone #: ______________________
Position: _______________________ Dates employed: from ________ to __________
Summary of your duties: _____________________________________________________________________________________
Reason for leaving: _________________________________________________________________________________________
Employer: _______________________________________________ Supervisor: ______________________________________
Address: ____________________________________________________________________________
Phone #: ______________________
Position: _______________________ Dates employed: from ________ to __________
Summary of your duties: _____________________________________________________________________________________
Reason for leaving: _________________________________________________________________________________________
May we contact your current employer?
Yes _____ No _____
REFERENCES Provide contact information of three people (not related) who could provide relevant comments
concerning your suitability for this position. If possible, include at least one UT faculty member or administrator.
Name: _____________________________________________
Organization: ______________________________________
Position: ________________________
Phone: ____________________ Email address: _______________________________
Address: ___________________________________________________________________________________________________
Name: _____________________________________________
Organization: ______________________________________
Position: ________________________
Phone: ____________________ Email address: _______________________________
Address: ___________________________________________________________________________________________________
Name: _____________________________________________
Organization: ______________________________________
Position: ________________________
Phone: ____________________ Email address: _______________________________
Address: ___________________________________________________________________________________________________
IMPORTANT. READ BEFORE SIGNING THIS APPLICATION.
Submission of this application does not obligate The University of Toledo (UT) to offer employment or the applicant to accept
employment. An offer of employment, if made, is for employment at will and is not to be construed as a guarantee of continued
employment. UT reserves the right to terminate employment at any time. Any employee also has the right to terminate his or her
employment with UT at any time.
I authorize investigation of all matters contained in this application that UT may deem relevant to my employment and authorize my
previous employers or other persons having information concerning me or my record to report such information to UT. Such persons
are hereby released from all liability for issuing such information. UT will keep all such information confidential except where such
information is required to be released by law or order of a court or other authority. I understand and agree that I will be subject to
immediate dismissal if it is subsequently discovered that the information herein is untrue or that I have failed to disclose a material
fact. I understand that if employed by UT, such employment will occur at will and no contract of employment, expressed or implied, is
created and that no representative of UT has any authority to enter into any agreement for employment of any specified period of time,
or to make any agreement contrary to the foregoing. I understand that if I receive an offer of employment and I accept the position, I
will be required to complete additional information necessary for UT record keeping requirements.
_____________________________________________________________________________
SIGNATURE
Student Application for Employment
________________________
DATE
The Carver Resource Center (CRC)