TA Application
ˆ
ˆ
EMPLOYER'S NAME and ADDRESS: SUPERVISOR'S PHONE NUMBER:
(
DESCRIPTION OF DUTIES:
REASON FOR LEAVING:
)
ˆ
ˆ
EMPLOYER'S NAME and ADDRESS: SUPERVISOR'S PHONE NUMBER:
(
)
DESCRIPTION OF DUTIES:
REASON FOR LEAVING:
FROM (mo/yr): TO (mo/yr): JOB TITLE or OCCUPATION: Part time
ˆ
Full time
ˆ
NAME OF YOUR DIRECT SUPERVISOR:
EMPLOYER'S NAME and ADDRESS: SUPERVISOR'S PHONE NUMBER:
(
DESCRIPTION OF DUTIES:
REASON FOR LEAVING:
)
FROM (mo/yr): TO (mo/yr): JOB TITLE or OCCUPATION: Part time
ˆ
Full time
ˆ
NAME OF YOUR DIRECT SUPERVISOR:
EMPLOYER'S NAME and ADDRESS: SUPERVISOR'S PHONE NUMBER:
(
)
DESCRIPTION OF DUTIES:
REASON FOR LEAVING:
DATE
EMPLOYMENT
HISTORY
Account for work experience during the last 10 years and describe specific duties that are relevant to the position for which you are
applying.
To allow for accurate review and
consideration,
your application should provide a complete and detailed description of your
work
experience. It is to your benefit to be as thorough as possible because this information will be used to determine if you are qualified for
this
position. You may attach an additional page if more space is required or refer to a résumé only for the duties
description.
FROM (mo/yr): TO (mo/yr): JOB TITLE or OCCUPATION: Part time Full time NAME OF YOUR DIRECT SUPERVISOR:
FROM (mo/yr): TO (mo/yr): JOB TITLE or OCCUPATION: Part time Full time NAME OF YOUR DIRECT SUPERVISOR:
EMPLOYMENT/EDUCATION
INFORMATION RELEASE
AUTHORIZATION
As an applicant for a position with California State University, Chico I do hereby authorize all past and present employers, references, institutions of higher education and
other appropriate persons or agencies to release to the University any and all information regarding my employment/education upon request. I do hereby agree to hold
such employers, institutions, references, persons, etc. harmless from liability for releasing said information.
SIGNATURE must be original DATE
APPLICANT
CERTIFICATION
I certify that the answers I have given in the materials I have submitted in application for this position are true and correct and that I have not knowingly withheld
any facts or circumstances. I understand that all answers given in my application for employment are subject to verification and that should I be employed at the
campus, any misrepresentation or omission of facts in this application may be sufficient reason for dismissal. The application materials include this document
and any other materials submitted.
SIGNATURE must be original
