APPLICATION FOR MBA EXECUTIVES (EMBA)
PERSONAL INFORMATION
FULL NAME:
LAST
FIRST
M.I
ADDRESS:
STREET ADDRESS
APARTMENT/UNIT #
CITY
STATE
ZIP
HOME PHONE:
WORK PHONE:
CELL PHONE:
WORK FAX:
PERSONAL EMAIL:
WORK EMAIL:
PROFESSIONAL INFORMATION
COMPANY/ORGANIZATION:
ADDRESS:
STREET ADDRESS
CITY
STATE
ZIP
TITLE OR POSITION:
TOTAL YEARS WITH COMPANY:
TOTAL YEARS OF WORK
EXPERIENCE:
TOTAL YEARS OF
MANAGEMENT/PROFESSIONAL
EXPERIENCE:
IMMEDIATE SUPERVISOR’S
NAME:
LAST
FIRST
M.I
IMMEDIATE SUPERVISOR’S
TITLE:
CURRENT ANNUAL SALARY
(CONFIDENTIAL/FOR STATISTICAL
PURPOSES ONLY)
EDUCATIONAL BACKGROUND
UNDERGRADUATE COLLEGE OR
UNIVERSITY:
MAJOR:
DEGREE:
YEAR:
GRADUATE UNIVERSITY:
MAJOR
DEGREE:
YEAR:
PROFESSIONAL DESIGNATIONS:
YEAR:
NON-DEGREE
PROGRAMS/COURSES:
YEAR:
APPLICANT ESSAYS
On separate sheets, please respond to the
following:
1.
Personal Statement (1 page
single-spaced).
o What do you expect to accomplish through the MBA for Executives
Program?
o What learning experiences do you expect, and how will you apply them
to
your
professional
career?
o What are your personal reasons for wanting to undertake this program
of study?
2.
Statement of Job Responsibility (2 pages
single-spaced)
o Describe the organizational unit to which you are attached and relate it to
the
total
organization in terms of size and scope of
business.
o Please give an accurate description of your
position.
o What is your scope of
responsibility?
o To what position do you
report?
o What is the scope and size of your profit-and-loss responsibility
?
o What are your management responsibilities with respect to
staff?
OPTIONAL INFORMATION
1
Providing this information is voluntary. The information you choose to provide will
be
used in a
nondiscriminatory manner, consistent with applicable civil rights laws, solely
for
required reporting under
federal and /or state
laws.
GENDER:
MALE
FEMALE
ETHNIC BACKGROUND:
AFRICIAN-AMERICAN
APPLICANT'S SIGNATURE
I certify that all statements made in this application for admission to the MBA Program
for
Executives (EMBA) at the Craig School of Business, California State University,
Fresno
are
correct to the best
of my knowledge. I realize that all documents submitted in
support
of
this application become the property
of the Craig MBA Program and California
State
University, Fresno. I understand and agree that any
misrepresentation or omission of
facts
in my application will justify the denial of admission or the cancellation
of admission
and/or
continuation in the
EMBA.
SIGNATURE OF APPICANT
DATE
1
California State University, Fresno and the Craig MBA Program will not discriminate in
any
employment practice,
education program, or educational activity on the basis of race,
color,
religion, national origin, sex, age, disability,
or veteran status. Our commitment to
equal
opportunity in c l u de s nondiscrimination on the basis of sexual
orientation.
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APPLICATION FOR MBA EXECUTIVES (EMBA)
RECOMMENDATION FORM
APPLICANT NAME:
LAST
FIRST
M.I
BUSINESS ADDRESS:
STREET ADDRESS
CITY
STATE
ZIP
APPLICANT: Please enter the information requested above and give this form to the individual you have asked to
provide an evaluation as part of your application. The recommender should complete the form and return it to:
EMAIL: TOMBU@CSUFRESNO.EDU
OR
PROFESSOR TOM BURNS, MANAGER, EMBA
CALIFORNIA STATE UNIVERSITY FRESNO
5245 N. BACKER AVE MS PB7
FRESNO, CA. 93740
RECOMMENDER
Your assessment of the applicant will greatly assist the Admissions Committee in its decision. Recommendations are
an important part of the application process and your time in furnishing this information is appreciated.
Recommendations are used for the admissions purpose only and do not become part of the permanent record file of
the student upon matriculation. Applicants do not have access to their recommendations.
Please answer the following questions:
1.
How long and in what capacity have you known the applicant?
2.
What characteristics do you consider the applicants principal talents or strengths?
3.
In what areas can the applicant improve?
4.
Using the chart below, please give us your personal appraisal of the applicant relative to others you have
known in a similar capacity.
Exceptional
(Top 2%)
Outstanding
(Top 5%)
Excellent
(Top 15%)
Good
(Top 33%)
Average
(Mid
33%)
Below
Average
(Bottom
33%
Not
Observed
Intellectual
Ability
Motivation
Ability to
work
with others
Creativity and
imagination
Oral
communication
skills
Written
communication
skills
Quantitative
Skills
Analytical
Skills
Please describe briefly the reference group against which you are rating the candidate:
5.
Please use the space below to make any additional comments concerning this applicant, particularly his/her
aptitude for graduate work and a career in business management. If additional space is needed, please feel free
to use a separate sheet.
Overall Rating:
Strongly Recommend
Recommend
Recommend with reservations
Do not recommend
SIGNATURE
DATE
NAME (PLEASE PRINT OR TYPE):
LAST
FIRST
M.I
TITLE:
EMPLOYER:
BUSINESS ADDRESS:
STREET
CITY
STATE
ZIP
TELEPHONE:
EMAIL:
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signature
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