Return to the SIC TRIO Office or Dara Cox, TRIO Advisor
SSS Mentor Job Application
Name: ____________________________________________________________________________
Phone Number: _____________________________________________________________________
Days/Hours Available to work
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Education:
Name and Address of School and Graduation Date
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Skills and Qualifications: Licenses, Skills, Training, Awards
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Return to the SIC TRIO Office or Dara Cox, TRIO Advisor
Employment History
Present or Last Position:
Employer: ______________________________________________________________________
Address: ________________________________________________________________________
Supervisor: ______________________________________________________________________
Phone: __________________________________________________________________________
Position Title: _____________________________________________________________________
From: ____________________To:______________________
Responsibilities: ________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Previous Position:
Employer: ____________________________________________________________________________
Address: _____________________________________________________________________________
Supervisor: ___________________________________________________________________________
Phone: _______________________________________________________________________________
Position Title: __________________________________________________________________________
From: ___________________To:___________________________
Responsibilities:
_____________________________________________________________________________________
________________________________________________________________________
_____________________________________________________________________________________
In the space below, please describe something about yourself – for example, a favorite sport, artist,
animal, or person? A humorous incident, a unique experience, or life altering event?