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2020-2021 Federal Work-Study Program Application
Financial Aid Office, P.O. Box 917, Henderson, NC 27536
Telephone: (252) 738-3280, Fax: (252) 738-3388, Email: fao@vgcc.edu
Students must meet all financial aid eligibility requirements to be considered for a work-study position. This
includes completing a FAFSA and all requested financial aid documents, meeting the Financial Aid Standards
of Academic Progress requirements, and demonstrating financial need. Priority is given to students who are
enrolled in at least 9 credit hours for the Fall or Spring and 6 credit hours in the Summer. Work-study
applicants must also complete a criminal background check by signing the background check waiver form.
NAME: ______________________________________________ STUDENT ID#:_________________________
ADDRESS: ______________________________________ CITY, STATE, ZIP: ____________________________
CELL PHONE #:_____________________________ HOME PHONE#:__________________________________
Date of Birth: ______________ ACADEMIC PROGRAM: ___________________________________________
Computer Skills and Qualifications: (please check all that apply)
____Personal Computer ____Microsoft Access ____Computer Scanning ____Typing (____wpm)
____Microsoft Word ____Microsoft Excel ____Microsoft Power Point ____Cash Handling
____Faxing/Filing ____Customer Service/Retail ____Switchboard/Telephone
Please list any additional clerical skills, qualifications or experience: ________________________________
Do you have reliable transportation? __________Which VGCC Campus do you prefer: __________________
Physical Ability: Some duties could require lifting approximately 50 lbs, climbing stairs, running errands, etc.;
your physical ability to fulfill this duty would be ______with or ______without reasonable accommodations.
Have you had any felony and/or misdemeanor convictions, excluding minor traffic violations?
Check Answer: YES____ NO____
If yes, please list details of convictions: _________________________________________________________
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2020-2021 Work-Study Application Revised Date: 06/17/2020/FAO
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Employment History: (Attach current resume or complete employment sections below.)
Current/Most Recent Employer: ___________________________ Date of Employment: ______________
Job Title: __________________________ Supervisor’s Name: __________________________________
Address: _________________________ City, State: _______________ Phone #:____________________
Duties and Responsibilities: _______________________________________________________________
Previous Employer: ____________________________________ Date of Employment: ____________
Job Title: _______________________ Supervisor’s Name: ____________________________________
Address: ________________________ City, State: ______________ Phone #:_____________________
Duties and Responsibilities: _______________________________________________________________
Previous Employer: ______________________________________ Date of Employment: ____________
Job Title: ________________________ Supervisor’s Name: ____________________________________
Address: _________________________City, State: ______________ Phone #:_____________________
Duties and Responsibilities: _______________________________________________________________
Certification:
I certify that the information provided is true and accurate. I understand that this information will be used in
accordance with federal guidelines and that submitting this form does not guarantee I will be approved for a
work-study position. If I purposely give false or misleading information on the form, I may be subject to a fine
of up to $20,000 or imprisonment for up to 5 years, or both.
Student Signature: __________________________________________ Date: ______________________
Office Use Only: _________________________________________________________________________
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2020-2021 Work-Study Application Revised Date: 06/17/2020/FAO
Waiver and General Release
Fax to Carolina Information: (919) 570-9864
Position Applying For
Full Name (Last) (First) MI Maiden/Other
Other Names Used in the Last 7 years (Dates) Daytime Phone Number
Race Sex Social Security Number Email Address
Drivers License Number State Date of Birth
List all of your places of residence for the past seven (7) years, beginning with your current address:
Street
City
County
State
Zip
From - To
Vance-Granville Community College is an equal opportunity employer. Applicants are considered and hired without
regard to race, sex, age color, religion, national origin, citizenship status, political affiliation or disability.
I hereby expressly authorize Vance-Granville Community College its agents and employees to make any
investigation of my personal or employment history, expressly including but not limited to, Federal and or State
criminal, law enforcement or traffic records and periodic/continual record checks after I am hired. I further
authorize any former employer, person, firm, corporation, credit agency, administrative body or government
agency to give any personal information they may have regarding me. In consideration of the review of my
employment application by Vance-Granville Community College I release Vance-Granville Community College, their
respective officers, directors, employees and agents, and all person, agencies and entities providing information or
reports about me from any and all liability arising out of the release of any such information or reports.
I certify that all information provided on this application supplement is accurate and complete. I agree that if any
information or answers to questions change either before or after employment, I will notify Human Resources in
writing immediately. I acknowledge that failure to provide accurate and complete information on this application
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Waiver and General Release Revised Date: 06/17/2020/FAO
supplement or failure to update this supplement with accurate and complete information in the future shall be
grounds for disqualification for employment or immediate dismissal.
Vance-Granville Community College agrees to inform you if an employment decision has been influenced by
information contained in a consumer report. Make all requests in writing to Carolina Information / USInfoGroup,
PO Box 127, Wake Forest, NC 27588 or call 919-570-9861 to obtain a free copy of your report.
Additionally, my signature below acknowledges that I have received a copy of the FCRA “Summary of my Rights”.
Signature Date
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Waiver and General Release Revised Date: 06/17/2020/FAO
click to sign
signature
click to edit
Para informacion en espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer Response Center, Room 130-
A 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.
A Summary of Your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files
of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus
and specialty agencies (such as agencies that sell information about check writing histories, medical records, and
rental history records). Here is a summary of your major rights under the FCRA. For more information, including
information about additional rights, go to www.ftc.gov/credit
or write to: Consumer Response Center, Room
130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.
You must be told if information in your file has been used against you. Anyone who uses a credit report or
another type of consumer report to deny your application for credit, insurance, or employment - or to take
another adverse action against you - must tell you, and must give you the name, address, and phone
number of the agency that provided the information.
You have the right to know what is in your file. You may request and obtain all the information about you
in the files of a consumer reporting agency (your "file disclosure"). You will be required to provide proper
identification, which may include your Social Security number. In many cases, the disclosure will be free.
You are entitled to a free file disclosure if:
o A person has taken adverse action against you because of information in your credit report;
o You are the victim of identity theft and place a fraud alert in your file;
o Your file contains inaccurate information as a result of fraud;
o You are on public assistance;
o You are unemployed but expect to apply for employment within 60 days.
In addition, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon
request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies.
See www.ftc.gov/credit
for additional information.
You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-
worthiness based on information from credit bureaus. You may request a credit score from consumer
reporting agencies that create scores or distribute scores used in residential real property loans, but you
will have to pay for it. In some mortgage transactions, you will receive credit score information for free
from the mortgage lender.
You have the right to dispute incomplete or inaccurate information. If you identify information in your file
that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must
investigate unless your dispute is frivolous. See www.ftc.gov/credit for an explanation of dispute
procedures.
Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information.
Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days.
However, a consumer reporting agency may continue to report information it has verified as accurate.
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Waiver and General Release Revised Date: 06/17/2020/ASA
Consumer reporting agencies may not report outdated negative information. In most cases, a consumer
reporting agency may not report negative information that is more than seven years old, or bankruptcies
that are more than 10 years old.
Access to your file is limited. A consumer reporting agency may provide information about you only to
people with a valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or
other business. The FCRA specifies those with a valid need for access.
You must give your consent for reports to be provided to employers. A consumer reporting agency may
not give out information about you to your employer, or a potential employer, without your written
consent given to the employer. Written consent generally is not required in the trucking industry. For more
information, go to www.ftc.gov/credit.
You may limit "prescreened" offers of credit and insurance you get based on information in your credit
report. Unsolicited "prescreened" offers for credit and insurance must include a toll-free phone number
you can call if you choose to remove your name and address from the lists these offers are based on. You
may opt-out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).
You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of
consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may
be able to sue in state or federal court.
Identity theft victims and active duty military personnel have additional rights. For more information, visit
www.ftc.gov/credit
.
States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may
have more rights under state law. For more information, contact your state or local consumer protection agency or
your state Attorney General. Federal enforcers are:
TYPE OF BUSINESS:
CONTACT:
Consumer reporting agencies, creditors and others
not listed below
Federal Trade Commission: Consumer Response
Center - FCRA Washington, DC 20580 1-877-382-4357
National banks, federal branches/agencies of
foreign banks (word
"National" or initials "N.A."
appear in or after bank's name)
Office of the Comptroller of the Currency
Compliance Management, Mail Stop 6
-6
Washington, DC 20219 - 800-613-6743
Federal Reserve System member banks (except
national banks,
and federal branches/agencies of
foreign banks)
Federal Reserve Consumer Help (FRCH)
P O Box 1200
Minneapolis, MN 55480
Telephone: 888
-851-1920
Website Address:
www.federalreserveconsumerhelp.gov
Email Address: ConsumerHelp@FederalReserve.gov
Savings associations and federally chartered savings
banks (word
"Federal" or initials "F.S.B." appear in
federal institution's name)
Office of Thrift Supervision
Consumer Complaints
Washington, DC 20552 800-842-6929
Federal credit unions (words "Federal Credit Union"
appear in
institution's name)
National Credit Union Administration
1775 Duke Street
Alexandria, VA 22314 - 703-519-4600
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Waiver and General Release Revised Date: 06/17/2020/ASA
State-chartered banks that are not members of the
Federal Reserve
System
Federal Deposit Insurance Corporation Consumer Response
Center, 2345 Grand Avenue, Suite 100
Kansas City, Missouri 64108
-2638 - 1-877-275-3342
Air, surface, or rail common carriers regulated by
former Civil
Aeronautics Board or Interstate
Commerce Commission
Department of Transportation , Office of Financial
Management Was
hington, DC 20590 - 202-366-1306
Activities subject to the Packers and Stockyards Act,
1921
Department of Agriculture Office of Deputy Administrator
GIPSA Washington, DC 20250 - 202-720-7051
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Waiver and General Release Revised Date: 06/17/2020/ASA
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