1
STUDENT APPLICATION FOR EMPLOYMENT
GENERAL INFORMATION
Name
Date of Birth
Last First Middle Ini al
Present Home Address
Street
City State
Zip Code
On Campus Address (if applicable)
Student ID Number
Home Telephone
Mobile Telephone
Expected Gradua on Date
Major GPA
Posi on Applied For (circle all that apply):
Campus Preference (select one): Midtown Westside No Preference
Salary Desired (hourly): $
Have you ever led an applica on here before?
Yes
No If yes, give date
Have you ever been employed here before?
Yes
No If yes, give date
Are you currently employed?
Yes
No
If yes, may we contact your employer?
Yes
No
How many hours can you work weekly (max. 20 during the semester)?
POSITION INFORMATION
Check o those computer skills with which you are profi cient.
COMPUTER SKILLS
Word Photoshop Illustrator InDesign
Acrobat Dreamweaver
Excel PowerPoint
PublisherAccess
Other. Please list:
MICROSOFT OFFICE
OPERATING SYSTEM
KNOWLEDGE:
ADOBE CREATIVE SUITE
FOR OFFICE USE ONLY
Approved Hourly Wage
Date of Interview
Date of Hire
Training Date
Assigned Loca on(s)
Notes/Informa on:
E-Mail:
Computer
Center Assistant
Training Specialist
ResNet Support SpecialistClassrom Technology Assistant
See final page for a descrip
on of each posi on available
Please indicate the semester you are applying for: Fall Spring Summer
Windows
Mac
Linux
2
WORK EXPERIENCE
Please list your previous work experience beginning with your most recent job held.
Type of School Name of School Loca
on (Complete mailing address) Years Completed Major & Degree
High School
College
Other
EDUCATION
Employer:
Address:
City, State, Zip
Dates
Employed:
Posi on
Held:
Supervisor
(Name & Title):
Descrip on
of Du
es:
Reason for
Leaving:
Employer:
Address:
City, State, Zip
Dates
Employed:
Posi on
Held:
Supervisor
(Name & Title):
Descrip on
of Du
es:
Reason for
Leaving:
Special Honors/Awards
Please list the informa on and areas of study for each school that you have a ended, excluding WCSU.
Student ID Number
3
REFERENCES
Please list two references other than rela ves or previous employers.
Name
Address
Telephone
Company &
Posi
on
OTHER SPECIAL SKILLS/MISCELLANEOUS INFORMATION
An applica on form some mes makes it dicult for an individual to adequately summarize a complete
background. Use the space below to summarize any addi
onal informa on necessary to describe your full
qualifica
ons and skill set, e.g., fluency in other languages, licenses, cer ca on, special training received for the
posi
on for which you are applying, etc.
Student ID Number
Years Known
Rela onship
Name
Address
Telephone
Company &
Posi
on
Years Known
Rela onship
AVAILABILITY
Please list the hours you can commit to work during the (check one): Fall Spring Summer
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
2:00pm-10:00pm 8:00am-11:00pm 8:00am-11:00pm 8:00am-11:00pm 8:00am-11:00pm 8:00am-4:00pm 10:00am-6:00pm
Facilities Open:
4
Student ID Number
Informa on Technology at Western Connec cut State University will provide an informa on technology
environment that delivers a seamless learning atmosphere for students, faculty, and sta. The University
will be a leader in using technology to enhance teaching and learning to meet the educa
onal needs of a
diversified student body, faculty, and sta. IT&I supports the University's mission of empowering
students, assuring eec
ve teaching, strengthening partnerships with people and ins tu ons while
suppor
ng con nuous improvement, and intellectual integrity.
REFERRAL SOURCE
Please check o the source which corresponds to your referral to this posi on.
Financial Aid Oce
WCSU Website
On-Campus Sign
Other. Please specify:
Friend
Employee Walk-In
I cer fy that answers given herein are true and complete to the best of my knowledge, as the informa on
provided in this document will be used as a basis for arriving at an employment decision. I understand that this
applica
on is not intended to be a contract of employment. In the event of employment, I understand that false or
misleading informa
on given on my applica on or interview may result in termina on.
Applicant Signature Date
INTEGRITY ASSURANCE
POSITION
DESCRIPTIONS
A Computer Center Assistant provides support in computer accounts and basic computer and program use to
students, faculty, and sta in the computer centers, as well as monitor and maintain the centers, 24-hour labs, and
technology classrooms on campus. A CCA also informs students of available technology resources at WestConn.
A Training Specialist provid
outlined above. Training Specialists may be asked to author new training materials, and hold workshops and one-on-
one tutorials. Hours are mostly on Midtown campus in the Student Technology Training Center SC 225 (STTC).
A ResNet Support Specialist
A Classroom Technology Assistant provides support for the technology in all WCSU classrooms. CTA’s do not have
include cleaning, checking, and maintaining the classroom technology on a weekly basis.
Applica ons received will be kept on file for one semester.
Posi
ons are filled on an as-needed basis.
IT_Student_
ons@connect.wcsu.edu
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