Office of Human Resources STUDENT EMPLOYMENT APPLICATION
Please print and complete
New 08-6-15; Rvsd 02-13-19
Position Title:
Department:
Job Posting Number:
PERSONAL INFORMATION
First Name:
Middle Initial:
Last Name:
Student ID
Address:
City:
State:
Phone Number (Where our office or an employer can reach you):
Email Address:
Pursuant to the Immigration Reform and Control Act of 1986, upon employment can you provide verification of your identity and
authorization to work in the United States?
____ Yes ____ No
ON CAMPUS WORK EXPERIENCE
Have you ever worked for Citrus College?
____ Yes (List all on campus work experience below. Add additional sheets if necessary). ____ No
Department:
Describe work
performed:
Type of employment:
___ Student Worker
___ Short-Term
___ Substitute
___ Other (Please specify)
Supervisor’s name:
Name used while
employed, if different
from above:
Start date:
End date (Leave blank if
still employed):
Total number of years and months:
Department:
Describe work
performed:
Type of employment:
___ Student Worker
___ Short-Term
___ Substitute
___ Other (Please specify)
Supervisor’s name:
Name used while
employed, if different
from above:
Start date:
End date (Leave blank if
still employed):
Total number of years and months:
Office of Human Resources STUDENT EMPLOYMENT APPLICATION
Please print and complete
New 08-6-15; Rvsd 02-13-19
Department:
Describe work
performed:
Type of employment:
___ Student Worker
___ Short-Term
___ Substitute
___ Other (Please specify)
Supervisor’s name:
Name used while
employed, if different
from above:
Start date:
End date (Leave blank if
still employed):
Total number of years and months:
Department:
Describe work
performed:
Type of employment:
___ Student Worker
___ Short-Term
___ Substitute
___ Other (Please specify)
Supervisor’s name:
Name used while
employed, if different
from above:
Start date:
End date (Leave blank if
still employed):
Total number of years and months:
Department:
Describe work
performed:
Type of employment:
___ Student Worker
___ Short-Term
___ Substitute
___ Other (Please specify)
Supervisor’s name:
Name used while
employed, if different
from above:
Start date:
End date (Leave blank if
still employed):
Total number of years and months:
Department:
Describe work
performed:
Type of employment:
___ Student Worker
___ Short-Term
___ Substitute
___ Other (Please specify)
Supervisor’s name:
Name used while
employed, if different
from above:
Start date:
End date (Leave blank if
still employed):
Total number of years and months:
Office of Human Resources STUDENT EMPLOYMENT APPLICATION
Please print and complete
New 08-6-15; Rvsd 02-13-19
OFF CAMPUS WORK EXPERIENCE
Employer Name:
Address:
City, State, Zip Code:
Name Used While Employed:
Begin Date:
End Date (Leave blank if still
employed):
Total Number of
Years/Months:
Job Title:
Number of Hours Worked
per Week:
Most Recent/Ending Salary:
Supervisor’s Name:
Describe Work Performed:
Employer Name:
Address:
City, State, Zip Code:
Name Used While Employed:
Begin Date:
End Date (Leave blank if still
employed):
Total Number of
Years/Months:
Job Title:
Number of Hours Worked
per Week:
Most Recent/Ending Salary:
Supervisor’s Name:
Describe Work Performed:
Employer Name:
Address:
City, State, Zip Code:
Name Used While Employed:
Begin Date:
End Date (Leave blank if still
employed):
Total Number of
Years/Months:
Job Title:
Number of Hours Worked
per Week:
Most Recent/Ending Salary:
Supervisor’s Name:
Describe Work Performed:
Office of Human Resources STUDENT EMPLOYMENT APPLICATION
Please print and complete
New 08-6-15; Rvsd 02-13-19
Are you currently receiving any Federal and/or California financial assistance? ____ Yes ____ No
Type: _____ Federal Work Study _____CalWORKs _____Other (Please specify)
________________________
Do you have any relatives (related by blood or marriage) who are currently employed at Citrus College?
____ Yes ____ No
If yes, provide name, department, and position held.
REFERENCES (Please provide a minimum of two references other than relatives.)
Name of Reference:
Title:
Institution/Business:
Phone Number:
How do you know this reference?
Name of Reference:
Title:
Institution/Business:
Phone Number:
How do you know this reference?
Name of Reference:
Title:
Institution/Business:
Phone Number:
How do you know this reference?
CERTIFICATION
Please be sure to read the following statements carefully and sign the application.
I certify that all of the information contained in this application is true and complete to the best of my knowledge and I understand
that, if I am employed, any statements I have falsified on this application shall be grounds for dismissal.
I certify that I will be enrolled in the minimum number of units required to maintain eligibility to work on campus during the
semester and/or intersession in which I am employed.
I hereby authorize this organization to investigate, through whatever means deemed appropriate, any information included in this
application and all facts resulting from the investigation unless otherwise noted.
BY SIGNING BELOW, I certify that I have read and agree with these statements.
__________________________________ _______________________________________________
Applicant’s Name Applicant’s Signature
_____________________________________
Date
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome