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CAREER SERVICES REGISTRATION DATA SHEET
Last Name: First Name:
Student ID Number:
Permanent Email Address:
Local Address:
Permanent Address:
Local Phone Number:
Permanent Phone Number:
Are you a U. S. Citizen? Yes No (Please Circle One)
If no, do you have authorization to work perma nently in the United States? Yes No
If no, have you applied for Practical Training? Yes No
Major:
Degree: Associate Bachelor Master
Graduation Date:
Grade Point Average:
Previous Degrees/Additional Majors or Minors:
Job Preference:
Location Preference:
Special Skills (include computer skills):
CREDENTIAL RELEASE STATEMENT
This is to certify that I, the undersigned, a student or graduate of the University of Arkansas-Monticello, hereby
authorize the Counseling, Testing, & Career Services of UAM to release copies of my registration file, resumes and
other information of an employment related nature, to interested employers, graduates schools, certification
agencies, etc. at their or my request, or at the discretion of the University of Arkansas-Monticello. I understand that
any or all information of an employment related nature once received by Counseling, Testing, & Career Services
becomes the property of that office. I further understand that I have the right to review the entire contents of my
file.
Signature:
Date:
click to sign
signature
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