Campus Student Officer Application

NAME AND CONTACT INFORMATION
 
First, Middle, Last Name
 
Date of BirthS.S. Number
 
Contact NumberOther NumberCellHomeWorkOther
 
Email
 
Home Address
 
City, State, Zip
 
School/Local Address, City State, Zip(if different from Home Address)

 
Do you posses a valid driver's licenseYesNo (answering "No" does not disqualify you from being hired)
If yes, D.L. Number D.L. State
 
 

SCHOOL INFORMATION
 
Are you a current student?YesNo
 
Undergraduate StatusFreshmanSophomoreJuniorSeniorMajor
 
 

ANSWER ALL QUESTIONS IN THIS SECTION
 
Have you ever been arrested or convicted for any crime other than minor traffic violation?
—Please choose an option—YesNo
 
Have you ever been fired or asked to resign from a job
—Please choose an option—YesNo
 
Have you ever been on probation?
—Please choose an option—YesNo
 
Do you now or have you ever used any illegal substances? (marijuana, cocaine, methamphetamine, heroin, LSD, Ecstasy, etc.)
—Please choose an option—YesNo

If you answered YES to any of the above questions, please explain below.

 

MILITARY SERVICE
 
Have You Served in the Military?—Please choose an option—YesNo
 

 National Guard—Please choose an option—Yes

          Reserves—Please choose an option—Yes

             Active—Please choose an option—Yes
 
Served FromToBranch—Please choose an option—ArmyNavyAir ForceMarinesCoast Guard
 
MOS/ Job Description
 
Discharged—Please choose an option—YesNoIf yes, was discharge HONORABLE—Please choose an option—YesNo
 
 

WORK EXPERIENCE
Last Job Held
 
Employer, Address, City, State

 
Job Title, Reason For Leaving

 
Dates of Employment(mm/dd/yyyy) to (mm/dd/yyyy) and Name of Superviosr

 
Other Work Experience You Would Like To Tell Us About

 
 

SKILLS AND ABILITIES
 
Skills and AbilitiesTell us about any special skills or abilities you possess

 
CommentsIs there anything else you would like us to know?

 

I certify that the information I provided on this application is true and correct to the best of my knowledge.
 

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