Employment Application Form Page 3
ADVERTISEMENT
1
2
3
4CLS
Position Applying for: __________________________
E
A
F
MPLOYMENT
PPLICATION
ORM
Campus Learning Assistance Services
Name:___________________________________________________________ Date of Birth: ___/___/____
Last
First
Middle
Perm # _______________-___
E-Mail: ______________________________________
Local Address: ____________________________________________________________________________
Street
City
State
Zip
Permanent Address: ________________________________________________________________________
Street
City
State
Zip
Cell Phone #(______)________________ Lab/Ofc. Ext # ___________ Other Phone # (______)_________________
U.S. Citizen?
VISA:
Expiration Date of Visa ____/____/____
Yes
No
Class ______ Country _______
Student Status: Registered UCSB student?
Class Level (current quarter): ______________
Yes
No
(e.g. Jr. Sr., Grad)
Major ______________________ Major G.P.A. ________________ Overall G.P.A. __________________
If you are a graduate student, where did you receive your Undergraduate degree? ___________________
Please indicate any previous tutorial, teaching or counseling experience: _______________________________
____________________________________________________________________________
In what courses/areas are you qualified to tutor? ___________________________________________________
____________________________________________________________________________
Maximum hours you are willing to work per week: ____________ Minimum hours: _____________________
Have you been employed by UCSB previously?
Dept. ________________________
Yes
No
When ___________ Position __________________ Home Dept (where paycheck is delivered) ____________
Will you be employed at UCSB for the upcoming academic year at another dept?
Yes
No
Dept ___________ Position _____________ Percent Time _____% Contact ___________ Ext. ___________
Do you have a Work Study allocation?
Maybe
Amount?______________
Yes
No
My “Letter of Recommendation” is:
FAXed
Attached
Being mailed (email or campus mail)
How did you hear about the position?: __________________________________________________________
Applicant’s Signature: ______________________________________________ Date: ________________
FOR OFFICE USE ONLY
: _______
_________
_______________________________
________________
Hired
Percent:
Program:
Date:
Coordinator’s Signature:
_________
__________
__________________________
Begin Date of Hire:
End Date:
_______________________________________________________________________________
Comments:
__________________________________________________________
Title Code: _______ Employment Data:
J:AdminFORMSCLAS-APPLICATION-PROCESSCLAS-App-Packet-GENERIC-TEMPLATE.docx
Rev. 4/22/16
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business