Student Employment Application
(Regular or Work-Study)
Revised: 10/31/2013
Name: Date:
Last First Middle
Address:
Street City State Zip Code
myWSU ID#: Telephone#:
E-mail address:
List clerical experience (i.e. answer phones, typing, filing, etc.) below:
List software application experience/computer skills/mechanical, construction, or other skills below:
Wichita State University Information:
Major: GPA: Currently enrolled? Yes No
Are you eligible for work study? Yes No
Are you currently employed in any other departments on campus? Yes No
If so, what department(s)?
Days and Time Available for Work:
Day: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
A.M.
P.M.
Total Hours Available to Work Per Week: Date of Availability:
Are you presently legally authorized to work in the United States? Yes No
Employment History: (Please list your work history below beginning with your present or most recent job.)
1. Employer: Phone Number:
Type of Business: Supervisor:
Employed from to May we contact? Yes No
Duties:
Reason for leaving?
Employment History (continued):
2. Employer: Phone Number:
Type of Business: Supervisor:
Employed from to May we contact? Yes No
Duties:
Reason for leaving?
3. Employer: Phone Number:
Type of Business: Supervisor:
Employed from to May we contact? Yes No
Duties:
Reason for leaving?
4. Employer: Phone Number:
Type of Business: Supervisor:
Employed from to May we contact? Yes No
Duties:
Reason for leaving?
References (name, business, relationship, telephone):
1.
2.
3.
To the best of my knowledge, all information on this application is true and correct. I authorize Wichita State University to
use the information given in determining my eligibility for employment, including contacting each of my former employers
listed concerning my qualifications for employment. Permission is also granted to each of my former employers to give
Wichita State University information they may have with respect to my work experience with them. I understand that
fraudulent statements made in this application may be cause for disqualification for employment at or dismissal from
Wichita State University.
Signature:
Date: