The Career Services Center
5074920142875SAMPLE ONLY00SAMPLE ONLY149161510668000Student Employment ApplicationPersonal InformationName: Today’s Date: ___ (Last) (First) (M.I.)Kent State ID #: KSU Email: ___Permanent Address: ___ (Street) (City) (State) (Zip)Local Address: ___ (Street) (City) (State) (Zip)Phone: Emergency Contact Name: Emergency Contact Phone: Check one:I have been awarded Federal Work StudyAward Amount: $___I have not been awarded Federal Work StudyEducational InformationMajor: Class Standing: FreshmanSophomoreJunior Senior Graduate StudentGPA: Anticipated Graduation Date: ___AvailabilityPreferred number of hours per week: Semester for which you are applying: less than 10Fall 10 – 15Spring 15+Summer Available work times (list all that apply):Monday Thursday Tuesday Friday WednesdaySaturdaySunday Specific skills and abilities (check all that apply): receptionist/phone customer service clerical marketing/graphics List computer skills (Word, Excel, etc.): List other skills: Position(s) applying for: Previous Work ExperienceOrganization NameEmployment DatesSupervisor NamePhone NumberJob Title & DutiesOrganization NameEmployment DatesSupervisor NamePhone NumberJob Title & DutiesOrganization NameEmployment DatesSupervisor NamePhone NumberJob Title & DutiesAdditional InformationHave you ever been convicted of a felony or misdemeanor (other than traffic violations)? ______ Yes ______ NoIf yes, explain in detail: (Conviction(s) will not necessarily disqualify an individual from employment)References (can be professional or personal) NameRelationshipYears Known Email AddressPhone NumberMay be contacted: Yes No NameRelationshipYears Known Email AddressPhone NumberMay be contacted: Yes No NameRelationshipYears Known Email AddressPhone NumberMay be contacted: Yes NoReturn to: Department Contact Information (Name, Address, Phone, Email, etc.) ................
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