Name: Last First Middle
School ID Number:
Number Street
Phone Number:
City State
Alternate Phone Number:
Position Desired:
Email Address:
Today’s Date:
Record of
Name & Address of School:
Course of Study:
High School:
Entered MCCC:
Current Credit Hours Registered:
Total Credit Hours Earned to Date: Are You: (circle one) Full-Time Part-Time
Program or Major of Study:
Semester you wish to work: (check all that apply) Fall Winter Spring Summer
you familiar with or have experience operating?
Typing Speed _______ Photocopier Phone Systems Fax
Windows MS Ofce Excel MS Ofce Word MS Ofce Database Apps.
esired position?
(manual labor, garden equipment experience, construction, sports/P.E., ect.)
Have you ever been convicted of any felony, crime or misdemeanor, other than trafc violation?
If yes, what was the nature of offense?
Are you 18 years or older?
(Please list your 2 most recent employers their phone numbers)
1555 Soutn Raisinville Road Monroe, MI 48161
Office of Workforce Development (734) 384-4229 Fax (734) 384-4190
A person with a disability requiring accommodation for completing the application
and/or the interview process should notigy the Ofce of Workforce Development
Application for Student Assistant Positions
Person to notify in case of Emergency (Name, Phone No.)
The class schedule on this form MUST be completed before you will be considered for a student assistant position. Please use your schedule for the semester you wish to work.
Signature:________________________________________________________ Date:____________________________
Class Schedule
8a - 9a
9a - 10a
10a - 11a
11a - noon
noon - 1p
1p - 2p
2p - 3p
3p - 4p
4p - 5p
5p - 6p
6p - 7p
7p - 8p
8p - 9p
9p - 10p
This information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application,
resume, or any other materials, or during any interviews, can be justication for refusal of employment, termination from Monroe County Community College.
I give Monroe County Community College the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy
of the information contained in this application, I hereby release from liability Monroe County Community College and its representatives for seeking, gathering and using such
information and all other persons, employers, or organizations for furnishing such information.
Mail to: Monroe County Community College
Attn: Workforce Development
1555 South Raisinville Road
Monroe, MI 48161-9746
Monroe County Community College is an equal opportunity institution and
adheres to a policy that no qualied person shall be discriminated against
because of race, color, religion, national origin or ancestry, age, gender,
marital status, disability, genetic information, sexual orientation, gender
identity/expression, height, weight or veteran’s status in any program or
activity for which it is responsible.