181 WHITE STREET, DANBURY, CT 06810 ~ STUDENT CENTER 227
(203)837-3954 OFFICE ~ (203)837-8213 FAX ~ CSI@WCSU.EDU ~ WWW.WCSU.EDU/STUDENTLIFE
STUDENT EMPLOYEE APPLICATION
Note: To be eligible, you must be a full-time student and have at least a cumulative 2.0 GPA
APPLICANT INFORMATION:
Name: Date:
(Last) (First) (Middle)
Student I.D. #: Date of Birth:
Campus Address (if applicable):
Permanent Address:
(City) (State) (Zip)
Cell Phone: Home Phone:
WCSU Email Address: @wcsu.edu Do you have Work Study? Yes No
Expected Graduation Date: Major: GPA:
Are you in any co-curricular activities? Yes No Are you involved in any athletics? Yes No
If yes, please describe:
Were you referred by anyone? If yes, please list their name, title and telephone:
Please give a brief explanation why you are interested in employment with Center for Student Involvement:
OVER
Cell #:
In case of an emergency, who should we contact:
1. Name: Relationship:
2. Name: Relationship:
Cell #:
181 WHITE STREET, DANBURY, CT 06810 ~ STUDENT CENTER 227
(203)837-3954 OFFICE ~ (203)837-8213 FAX ~ CSI@WCSU.EDU ~ WWW.WCSU.EDU/STUDENTLIFE
ON CAMPUS EMPLOYMENT HISTORY:
Have you ever had employment on campus before? Yes
No
If yes - Department:
From: To:
Supervisor: Phone #:
If no, please provide contact information for an on campus reference:
Name: Department:
Phone #:
OFF CAMPUS EMPLOYMENT HISTORY: (Start with the most recent position)
1. Employer: From: To:
Position: Supervisor:
Phone #:
2. Employer: From: To:
Position: Supervisor:
Phone #:
COMPUTER SKILLS: Check off the computer skills in which you are proficient
MICROSOFT: Outlook Word Excel Publisher Access
ADOBE SUITE: Photoshop Illustrator InDesign Acrobat Dreamweaver
OTHER:
HOURLY WAGE
DATE HIRED
TRAINING DATE
FOR OFFICE USE
ONLY
DATE OF INTERVIEW:
POSITION:
INTERVIEW NOTES:
~ Please attach additional employment history, information you would like to share (if any)
and your class schedule for the upcoming semester ~
Once completed, please submit the application and current schedule at the Center for Student
Involvement; Student Center 227 or email to CSI@wcsu.edu Attention: Oni Figueroa
Please sign below acknowledging that the information provided above is correct to the best of your knowledge.
Signature: Date:
POSITION INFORMATION:
How many hours can you work weekly (max. 20 hours during the semester)?
Are you currently employed? Yes No If yes, may we contact your employer? Yes No
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