APPLICATION FOR EMPLOYMENT
Summer Session
Name ____________________________________________________ Date _________________________________
E-mail: ______________________________ Cell Ph. _______________________ Text Enabled? ⃞ Yes ⃞No
College Address ____________________________________________________ FB/Instagram? ⃞ Yes ⃞No
Home Address ___________________________________________________________________________________
Cum. GPA ____________ Advisor/s
A copy of your transcript (unofficial accepted) and a resume are also required.
Expected Grad Date ________________ Major _____________________Minor _____________________
1. Have you previously worked for a TRIO program? ⃞ Yes ⃞No
If yes, which program, where, and when? ___________________________________________________________
2. Please mark any of the following that you are certified in: ⃞CPR ⃞First Aid ⃞Lifeguard
3. Are you willing to learn about and drive a 16-passenger van? ⃞Yes ⃞No
4. Have you ever worked with high school students before? ⃞Yes ⃞No
If yes, describe in what capacity __________________________________________________________________
5. Have you ever tutored before? ⃞Yes ⃞No If yes, at what level? ________________________________
What subjects would you feel comfortable tutoring? __________________________________________________
6. Have you ever worked with teenagers in a mentoring capacity before? ⃞Yes ⃞No
If yes, describe in what capacity _________________________________________________________________
7. Have you ever worked in a residential setting before? ⃞Yes ⃞No
If yes, describe in what capacity _________________________________________________________________
8. Have you ever been a TRIO program participant? ⃞ Yes ⃞No
If yes, which program, where, and when? __________________________________________________________
9. List any present employment, including work study, and include your supervisor as a reference below.
____________________________________________________________________________________________
10. List any extracurricular activities or organizations in which you are involved (e.g., social or academic).
____________________________________________________________________________________________
11. List any special interests or skills you have that may enhance your work with APPLE UB.
____________________________________________________________________________________________
12. Please provide contact information for three references: (Job Title: e.g. Prof. of Biology, NOT Doctor)
Name _____________________________Job Title ________________________ E-mail ______________________
Name _____________________________Job Title ________________________ E-mail ______________________
Name _____________________________Job Title ________________________ E-mail ______________________
APPLE UB is an equal opportunity employer and encourages the nomination and application of
women and members of racial and ethnic minority groups. Preference is given to applicants who
have overcome barriers similar to those faced by our targeted student population.
