BUTTE-GLENN COMMUNITY COLLEGE DISTRICT DEPARTMENT OF HUMAN RESOURCES
APPLICATION FOR STUDENT EMPLOYMENT
(RETURN TO HUMAN RESOURCES OFFICE UPON HIRE)
PERSONAL INFORMATION (Please use ink & print legibly) Date: Butte ID:
Name:
Last, First Middle
Present Address:
Street / City / Zip Code
Home Phone: Cell Phone: E-mail:
EMPLOYMENT DESIRED
Date you Are you presently May we contact
Department: can start: employed? Yes No your present employer? Yes No
If no, why not?
EDUCATION-COLLEGE
Name/s & Location/s
Subjects Studied
Units Completed
GPA
EDUCATION-HIGH SCHOOL
Name/s & Location/s
Did You Graduate?
GPA
AVAILABLE WORK SCHEDULE Type an X in each box you are NOT available to work. Are you willing to change your schedule? Yes No
CHE
CK ONE: FALL SEMESTER SPRING SEMESTER
Please list any extra-curricular activities you’re involved in.
Can
you provide proof of eligibility to work in the U.S. at Butte College? Yes No
Monday
Wednesday
Friday
8-9
9-10
10-11
11-12
12-1
1-2
2-3
3-4
4-5
Rev 3/3/15
EMPLOYMENT HISTORY
Job Title
Employer Name & Address
Name of Supervisor
Phone
Dates (from/to)
Hourly Wage
Reason for Leaving
Job Title
Employer Name & Address
Name of Supervisor
Phone
Dates (from/to)
Hourly Wage
Reason for Leaving
Job Title
Employer Name & Address
Name of Supervisor
Phone
Dates (from/to)
Hourly Wage
Reason for Leaving
REFERENCES (List below the names of three person not related to you, whom you have known at least 3 years)
Name
Occupation
Relationship
Phone
Years Known
Do you have any relatives currently working at Butte College? Yes No
Name
Relationship
Department
SUPPLEMENTAL QUESTIONS (please answer in your own handwriting)
1. What is your major?
2. What are your long-term career goals?
3. To date, what has been your greatest achievement?
4. Describe yourself in 3 words.
5. Please describe any work-related skills (typing speed, 10-key, computer software/hardware, certificates, training).
6. Why should we hire you?
NOTE: Your signature below authorizes Butte College to:
1) Contact your employers and references and
2) Investigate all statements contained in this application.
I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite
period and may, regardless of the date of payment of my wages, be terminated at any time without previous notice. Butte College is an Equal Opportunity
Employer. Women, ethnic minorities, the disabled and other protected groups are encouraged to apply.
Signature Date
click to sign
signature
click to edit
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