JACKSONVILLE STATE UNIVERSITY
Student Life Student Worker Application
Student Number: ______________________ Date: _____________________________
Name: _________________________________________________________________
Address: _______________________________________________________________
Home Telephone: (
) ________________ Cell Phone # (
) __________________
E-mail Address: _________________________________________________________
Are you legally authorized to work in the United State?
____Yes ____ No
Can you provide required proof of eligibility to work?
____Yes ____ No
Have you previously been employed by this University?
____Yes ____ No
If yes, from ___________________________ to ______________________________
In what position? _______________________________________________________
Have you ever been convicted of a felony? ____Yes ____ No
If yes, please explain: ____________________________________________________
______________________________________________________________________
______________________________________________________________________
EDUCATION
High School ____________________________________________________________
City/State ____________________________________ Did you graduate? ___________
Degree __________________ Major(s): ______________________________________
REFERENCES
Please list three persons who have knowledge of your work experience. (Other than prior
employers or relatives).
1.______________________________________________________________________
(NAME)
(TELEPHONE NUMBER)
2.______________________________________________________________________
(NAME)
(TELEPHONE NUMBER)
3.______________________________________________________________________
(NAME)
(TELEPHONE NUMBER)
WORK HISTORY
List all positions held starting with most recent.
Employer: _______________________________________________________________
City/State: _______________________________________________________________
Name/Title of Immediate Supervisor: ____________________ Phone: _______________
Dates of Employment: From ______________ to ________________
Reason for Leaving: _______________________________________________________
Employer: _______________________________________________________________
City/State: _______________________________________________________________
Name/Title of Immediate Supervisor: ____________________ Phone: _______________
Dates of Employment: From ______________ to ________________
Reason for Leaving: _______________________________________________________
Employer: _______________________________________________________________
City/State: _______________________________________________________________
Name/Title of Immediate Supervisor: ____________________ Phone: _______________
Dates of Employment: From ______________ to ________________
Reason for Leaving: _______________________________________________________
PLEASE PROVIDE THE DAYS AND HOURS YOU ARE AVAILABLE FOR WORK:
DAYS
Monday
Tuesday
Wednesday
Thursday
Friday
TIMES
________________
________________
________________
________________
________________
WORK-STUDY
POLICIES AND PROCEDURES
Work Schedule
Student work schedule will be arranged around classes for an average of 3 hours per day, not to
exceed 15 hours per week. Work schedules may vary during final exam periods. Student is
expected to work all scheduled hours unless approved by supervisor.
Attendance and Punctuality
Although situations will arise when you cannot be on time, please try to make a habit of being
prompt. Student must call prior to scheduled hours if unable to work scheduled time/day.
Student Payroll
The federal work-study program is administered through funds provided by the Federal
Government and JSU. Eligible students will work up to an average of 15 hours per week and
earn a minimum wage.
Student paychecks will be distributed to the student’s post office boxes by 2:00 p.m. on the
fourth work day of the month. Checks for students without a campus post office box will be
mailed to the address in their student payroll file on the fourth work day.
The Internal Revenue Service has issued a new Revenue Procedure on Student FICA
withholding. The procedures exempt from FICA taxes students who are enrolled half-time,
regardless of the number of hours worked.
Personal Appearance and Dress Code
Use good judgment at all times regarding your personal appearance. You are expected to be
neat and to wear clean clothing. Clothing with school emblems is not allowed unless it is JSU
clothing.
Customer Oriented Skills
As a JSU Student Worker, you will contribute significantly to the image the public has of the
university. Your contacts with faculty, students, alumni, visitors and the community place you
as a representative of JSU. It is important that you treat these individuals courteously and
thoughtfully. The same qualities which you appreciate in others will make you a valuable
worker. Tact, dependability, punctuality, and a friendly attitude will continue to make JSU the
“Friendliest Campus in the South.”
Telephone Calls and Visitors
University property and equipment have been purchased with university funds and are for
university use only. The telephone is an important link between the university and its students,
alumni, and other constituents. Prompt and courteous answers to telephone calls are essential.
JSU phones are for university business. While we realize that employees will need to make
personal calls occasionally, the university insists that incoming and outgoing personal calls be
kept to a minimum.
The university requests your cooperation and discretion in the use of the telephone.
Casual calls and visitors must be discouraged. Other university property, e.g. copiers,
computers, office supplies, are also for university business only.
Confidentiality
During the course of performing his/her duties, student workers will see or hear
confidential information, such as disciplinary information, budgetary, or financial
information. This information should be discussed only with those who absolutely need
to know. Such information should not be discussed outside the University. Anyone
responsible for releasing confidential information could leave themselves open to charges
of invasion of privacy.
Sexual Harassment
The University is firmly committed to providing an environment that is free from all
forms of sexual harassment. Sexual harassment includes unwelcome sexual advances,
request of sexual favors, and other verbal and/or physical conduct of sexual nature.
Sexual harassment may occur when submission to, or rejection of, such conduct by an
individual is used as a basis for employment, or academic decisions affecting such
individuals. It may also occur when such conduct has the purpose or effect of
unreasonably intervening with an individuals work performance or creating a hostile or
offensive work environment. Such behavior may violate federal law and/or give rise to
personal liability for the results of the behavior. Therefore, JSU prohibits all forms of
sexual harassment and will investigate claims thoroughly and with seriousness. If you
feel you’ve been a victim of sexual harassment, you may report the incident to your
supervisor, the Vice President for Academic and Student Affairs, or the Personnel Office.
HIRING/PROBATION PERIOD
Upon meeting requirements for employment with the Office of Student Life, a request for
work study employment will be submitted to the Financial Aid Office to determine
eligibility. Upon approval from Financial Aid the student will be hired for a 30 day
probationary period. After the probationary period is served, evaluation of
performance will determine the retention of the student for permanent employment.
Upon receiving permanent employment, performance will be evaluated each semester.
I have read and agree to abide by the policy and procedures for student workers in
the Office of Student Life and Jacksonville State University. I understand that
failure to comply with these policy and procedures could result in termination of my
employment.
_______________________________________________________________________
Signature
Date