Student Residential Assistant Selection Process
Please submit your current resume and references along with this form.
Applicant Information
Name: _____________________________________ Nickname: _________________
Last First Middle Initial
Student ID Number: ____________________________ Gender : F M
Date of Birth: _______/______/_______ E-mail Address: ________________________
Month Day Year
Current Address: _______________________________ Home/Cell Phone: _________
_________________________________ Cell Phone: ______________________
City State Zip Code
Permanent Address: ______________________________ Home Phone: ___________
(If Different From Above)
______________________________
City State Zip Code
Present Academic Classification (i.e., Junior, Senior, etc.): _______________________
Major: __________________ Completed Credit Hours: ______Cumulative GPA: _____
Employment Information
Indicate past employment positions, including all employment at Coahoma Community
College (please do not write “see resume”):
Places of Employment: Dates of Employment: Position Held:
_______________________ _____________________ ____________________
_______________________ _____________________ ____________________
_______________________ _____________________ ____________________
_______________________ _____________________ ____________________
_______________________ _____________________ ____________________
Community Service and Extracurricular Activities
Please indicate any organizations and activities that you have been involved in and any
leadership positions held:
Organization/Activity: Dates/Years Involved: Leadership Position:
_____________________ _____________________ ______________________
_____________________ _____________________ ______________________
_____________________ _____________________ ______________________
_____________________ _____________________ ______________________
Reference Process
The residential director requires that each applicant provide at least two references. An
appropriate reference is an independent individual (not a family member) who can
provide an objective assessment of the applicant's background and capabilities with
respect to the job position. At least one reference must be from a nonacademic source;
a person who has been a direct supervisor of the applicant. Student Engagement
Housing also reserves the right to solicit additional references relative to your
application. After the application has been completed and returned to Student
Engagement Housing, it becomes the exclusive property of Coahoma Community
College. Applications are classified as personnel materials and are subject to complete
confidentiality.
By submitting this application, you acknowledge that you have read and understand the
duties and responsibilities of the position, including but not limited to duty requirements
(specific to dormitory life) and mandatory training dates. Acceptance of the position
mandates that you commit to work exclusively for Student Engagement-Housing for
either four or seven weeks (depending on individual contracts).
Please sign below after reading the following statement:
The information I have furnished on this application is true and correct, to the best of
my knowledge. I acknowledge that intentional falsification of statements on this
application will result in my disqualification as an applicant for a position in Student
Engagement Housing.
_____________________________________________________________________
Signature of Applicant Date
All questions regarding the SRA selection process should be directed to Student Engagement-Housing
by calling Fitzgerald Jones at 662-621-4039, Eugene Polite at: 662-621-8485, Dian Thomas at
662-621-4045, or Felicia Johnson at 662-621-4069
Coahoma Community College is an equal opportunity employer.
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