Student Staff Application 2016-2017

Campus Store Part Time Employee

Name: / Type name here / Brock Student#:
LOCAL ADDRESS (while at Brock) / HOME ADDRESS (if different)
Street: / Street:
City: / City:
Postal Code: / Postal Code:
Phone #: / Phone #:
Brock email: / Home email:
Academic Program:
Are you a full-time Brock student? / Choose oneyesno

Number of years remaining at Brock, not including this year.:

Have you used a POS system? / Choose oneyesno
(i.e.: cash register)
If yes, where?
Do you have previous customer service experience? / Choose oneyesno
If yes, where?
Are you familiar with working in a retail environment? / Choose oneyesno
If yes, in what capacity? / Use "tab" to type on the next line
What was your level of responsibility in your previous retail position? (e.g.: cashier, key holder, etc.)
Have you worked for another area of Brock (e.g. Don, tour guide, BUSU)?
If yes, where?
Have you been responsible for cash handling? / Choose oneyesno
If yes, where? Please provide an example. / Use "tab" to type on the next line
Do you have any other affiliations with Brock? (e.g.: club, volunteer, tutor, etc..) / Choose oneyesno
If yes, with who: / Use "tab" to type on the next line
Are you a varsity athlete? / Choose oneyesno / If yes, what sport?

The Campus Store operates 6 days per week, which includes daytime, evening, weekend and school break shifts. Please initial if you understand that you may be scheduled to work these shifts provided they do not interfere with your classes.

Initial here

Have you ever been convicted of any criminal offense in respect to which a pardon has not been granted under the Criminal Records Act and has not been revoked? yesno
If yes, please list offenses for which you have been convicted?

Please read and sign the following statement:

“I agree that misrepresentation of facts by me in this application shall be sufficient cause for dismissal if I am employed by Brock University.”

Date (Day/Month/Year)Signature

Protecting Your Information

Personal information is collected under the authority of The Brock University Act, 1964, and in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA) for the administration of the University and its programs and services. For details on the use and disclosure of this information call the Campus Store at the University at (905) 688-5550, ext. 3748.

*Please attach a copy of your cover letter, current resuméand email it to by February 12 2016

Due to the volume of resumes we receive, only applicants selected for interviews will be contacted. Interviews begin March 7