/ Office of Student Life
102 Holton Hall
Manhattan, KS 66506-1303
785-532-6432

Submit completed application, resume, and cover letter to the Office of Student Life via email at . Incomplete application materials will not be considered.

Applicant Information

Full Name: /
WID #::

Last

/

First

/

M.I.

Address:

Street Address

/

Apartment/Unit #

City

/

State

/

ZIP Code

Phone: /
Email
Are you eligible for work study? / YES / NO
Have you ever been found in violation of a code of conduction or honor & integrity violation? / YES / NO /
If yes, when?
Have you ever been convicted of a felony? / YES / NO
If yes, explain:

Hours Available

Please list the hours between 8:00 am and 5:00pm that you are available for work in the Fall 2016 semester. If you have enrolled for Spring 2016, please attach a copy of your class schedule.
Monday / Tuesday / Wednesday / Thursday / Friday

References

Please list three professional references.

Full Name: /
Relationship:
Company: /
Phone:
Address:
Full Name: /
Relationship:
Company: /
Phone:
Address:
Full Name: /
Relationship:
Company: /
Phone:
Address:

Previous Employment

Company: /
Job Title:
Address: /
Supervisor:
Responsibilities:
From: /
To:
/
Reason for Leaving:
Company: /
Job Title:
Address: /
Supervisor:
Responsibilities:
From: /

To:

/

Reason for Leaving:

Company: /

Job Title:

Address: /

Supervisor:

Responsibilities:
From: /

To:

/

Reason for Leaving:

Other

List volunteer and K-State student organization experience and affiliates below:

Disclaimer and Signature

To the best of my knowledge, all answers to the foregoing are true and correct. I hereby grant permission to Kansas State University to contact each of my former employers listed above concerning my qualifications for employment. Permission is also granted to each of my former employers to give Kansas State University information they may have with respect to my work experience with them.

Signature: /

Date:

Notice of Nondiscrimination:

Kansas State University is committed to a policy of nondiscrimination on the basis of race, sex, national origin, handicap or other nonmerit reasons, in admissions, education programs or activities and employment, all as required by applicable laws and regulations. Responsibility for coordination of compliance efforts and receipts of inquiries, including those concerning Title IX of the Education Amendments of 1972 and Section 504 of the Rehabilitation Act of 1973, has been delegated to Jane D. Rowlett, Ph.D., Director, Office of Academic Services, 211 Anderson Hall, Kansas State University, Manhattan, KS 66506, (785) 532-4392.

1