Nash Community College
Federal Work-Study Application
The Federal Work-Study Program is an opportunity for undergraduate students to receive
practical work experience that will enhance their job skills. Jobs are on campus (approximately
12-25 hours/week) and hours are scheduled around your class schedule.
To be considered for a work-study position, the student should have completed the FAFSA
application, have a GPA of at least 2.0 or better, and be enrolled at least half-time (6 or more
credit hours).
If you are selected for an interview for a work-study position you will be contacted by phone
and/or e-mail. Please make sure that a valid phone number is provided on the application. We
will keep this application on file for the 2016 – 2017 academic school year for consideration
when jobs become available.
The applicant hereby acknowledges and agrees that acceptance of this application and placement
in a work-study assignment is not a representation or promise of future employment or other
contractual arrangement with Nash Community College. Placement in a work-study assignment
does not and will not confer eligibility upon applicant for any employment-related benefits such
as medical insurance, life insurance, vacation or sick leave.
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Nash Community College
Federal Work-Study Application
Last First Middle Maiden
City State ZIP
Student ID# Major
Phone # E-mail
Program of Study
Extracurricular interest
- Previous Work Experience
Employer Position Title
Address Phone
Job Description
May we contact employer? Yes/No Supervisor's Name
Dates of Employment to Reason for leaving
Skills and/or Training
Do you have transportation available? Yes/No
Have you ever been convicted of an offense against the law other than a minor traffic violation? Yes/ No
If yes, explain fully on an additional page. A conviction does not mean you cannot be hired. The offense and how
recently you were convicted will be evaluated in relation to the position for which you are applying. Failure to disclose
this information may affect your selection for participation in this program.
List the names of three (3) individuals, other than relatives, we may contact for references. Two (2) of the reference
sources should be job-related.
1. Name _________________________ Address ______________________________ Telephone _____________
2. Name _________________________ Address ______________________________ Telephone_____________
3. Name _________________________ Address ______________________________ Telephone _____________
Declaration of Applicant
This application does not guarantee a position in the work-study program. If your Pell Grant is terminated your work-
study position will be terminated as well. Student placement is based on funding and eligibility.
I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements
and answers to questions. I am aware that should an investigation disclose any misrepresentation, omission, or
falsification, my application may be rejected, or if already employed, my employment may be terminated.
I understand that North Carolina is an employment at will state. Although it is desirable for employees of Nash
Community College to form long-standing employment relationships with the College, either the employee or the
College may terminate the relationship at any time, for any reason, with or without notice. Neither the College policies
or practices nor its employee procedures are intended to alter an employee's at will relationship.
I permit Nash Community College to examine my references, record of employment, education record, and any other
information I have provided. I authorize the references I have listed to disclose any information related to my work
record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I
release Nash Community College, my former employers & all other persons from any & all claims, demands or
liabilities arising out of or in any way related to such examination or revelation.
Print Full Name
Signature Date
Your interest in Work-Study at Nash Community College is very much appreciated. The college wants to
find the best qualified people available. Although everyone who applies cannot be hired, your application
will be given every consideration. Thank you for offering your services to Nash Community College.
Nash Community College does not discriminate on the basis of race, color, national origin, sex, disability,
or age in its programs and activities. The following have been designated to handle inquiries regarding
the non-discrimination policies:
Lindsay Stokes Michelle Noyes
Director of Counseling & Disability Services Director of Human Resources
522 North Old Carriage Road 522 North Old Carriage Road
Rocky Mount, NC 27804 Rocky Mount, NC 27804
Office Use Only
GPA ______ Enrollment Status New ___ Returning ___
Credit Hours: Fall ______ Spring ______ Summer _____
Updated 2012
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