NAME: Last, First Middle CURRENT ADDRESS: Street, City, State Zip PHONE: EMAIL ADDRESS:
Date you could start work:
MAJOR: 1st MINOR: 1st 2nd 2nd
CAREER OBJECTIVE:
Have you been a College Work-Study employee at NSU previously? Yes No
Do you want to work for one of the above? Yes No If Yes, which one? 1 2 3
Do you have any physical defects which would prevent you from performing certain jobs? Yes No If yes, describe defects & specific work limitations:
Have you attended a Business or Vocational School? Yes No
List any courses you have successfully completed that might qualify you for certain postions:
List any work or volunteer experience(s) you have had:
REFERENCES: (other than work-study supervisors listed above)
IN CASE OF EMERGENCY NOTIFY: Name, Address, Phone Would you be willing to work during enrollment? YesNo
PLEASE CHECK ON RESPONSE TO EACH STATEMENT:
HOBBIES:
All the information listed by me on this application is true and correct to the best of my knowledge. I understand employment will depend upon work performance of a continuting satisfactory standard.