Last Updated: 6/26/19
APPLICATION FOR WORK STUDY EMPLOYMENT
Name __________________________________________________________________________________________________________________________
Last First Middle
Address _________________________________________________________________________________________________________________________
P.O. Box/Street City State Zip
Telephone Number ___________________________________________________Student ID# __________________________________________________
Position applied for ___________________________________________________Department____________________________________________________
Do you have any experience, knowledge, skills, abilities, or qualifications that you feel would especially fit you for work with Eastern Arizona College in the
position applied for?
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Are you related to anyone employed at EAC? If so, who?
________________________________________________________________________________________________________________________________
List below the last two places of employment, beginning with current or most recent employment:
Name__________________________________________________________________Job Title__________________________________________________
Address________________________________________________________________Supervisor________________________Phone __________________
Hourly Wage____________ From:____________To:_________Reason for leaving____________________________________________________________
Describe the work you did including major responsibilities of your position: __________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Name________________________________________________________________Job Title____________________________________________________
Address______________________________________________________________Supervisor____________________________Phone ________________
Hourly Wage_____________From:____________To:_________Reason for leaving____________________________________________________________
Describe the work you did including major responsibilities of your position:___________________________________________________________________
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
I certify that the information provided in this application is true and complete to the best of my knowledge.
___________________________________________________________ _________________________________________________
Applicant Signature Date
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