Districtwide Student Hire Card
(Referral Card)
To be completed by student
____________________ _________________ __________________ _________________
Last Name First Name Middle Student ID No.
____________________ _________________ __________________ _________________
Street Address City Zip Code Home Telephone
_____________________________________________________________ _________________
Emergency Contact Name, Relation and Address: Contact Phone
______________________________________
Signature Date
To be completed by Financial Aid (if applicable)
__________________ _________________ ______________________________________
Annual Amount Cumulative GPA Signature Date
To be completed by Hiring Manager
Location Status Term
________________________________________ ________________ ___________________
Job Title Hourly Wage Hours/Week
__________________ ________________ ________________ ___________________
TB Clearance Date (if applicable) Start Date End Date Position ID
___________________
Enrollment Check: Pay Level: Position ID
☐ ≥ 6 units (U.S students Fall/Spring)
☐ Student Worker (most jobs) ___________________
☐ ≥ 12 units (International students Fall/Spring) ☐ Student Intern/Tutor Position ID
☐ ≥ 3 units (Summer) ☐ Police Aide Corporal
________________________________________
Department
________________________________________ ______________________________________
Name of hiring manager Signature Date
________________________________________
Name of Proxy (Next Level Sup.)
To be completed by Business Office or Employment Center
_____________________ ______________________________________
Actual units of enrollment Signature Date
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signature
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