Northwest Missouri State University

Talent Development Center

Application for Student Employment—Undergraduate

Please check the position that you are applying for:

Office Assistant Tutor (list subjects) ______

SI Leader ®List course & Instructor: ______

Student Engagement Leader ®List course & Instructor: ______

Date Available for work: ______Date of Application:______

Personal Data: (please print)

Bearcat ID No.: 919-______Email (University-assigned)_S______

Name: ______

(Last) (First) (Nickname) (Middle)

Local Address: ______

(Street) (City) (State) (Zip)

Local Phone: ______Cell Phone: ______

Permanent Address: ______

(Street) (City) (State) (Zip)

Permanent Phone: ( ) ______Academic Advisor’s name: ______

Education:

Course of Study (major/s) ______GPA______

(minor/s, if applicable) ______

Year in

School: Freshman Sophomore Junior Senior Graduate

How long do you anticipate attending Northwest? ______

Have you ever worked for the University before? If so when______

List any relatives presently employed by Northwest: ______

Why are you interested in a position at the Talent Development Center?______

______

What factors motivate you to do your best work? ______

______

What are your personal/career goals? ______

______

What other abilities or talents do you have that would make you a valuable asset to the TDC (Example: presentation skills, specialized training you received, or experiences, etc.)?

Hobbies:

Campus Activities and Organizations: (not needed here if you list them on your resume)

References (on campus):

1. Faculty: ______Phone: ( )______

2. Faculty: ______Phone: ( )______

Employment History: (most recent position first)

1. Employer:______Dates of Employment: ______

Type of Business:______Supervisor’s Name:______

City and State:______Phone: ( )______

Job Title and duties:______

Reason for Leaving:______

2. Employer:______Dates of Employment: ______

Type of Business:______Supervisor’s Name:______

City and State:______Phone: ( )______

Job Title and duties:______

Reason for Leaving:______

Schedule: Number of hours you are available to work each week? ______

Along with this application submit the following items all together. Incomplete submissions will not be considered.

1. An unofficial copy of your transcript or copy of your degree audit

2. A resume

I authorize Northwest Missouri State University to investigate any of the information contained in this application for employment, except where my written statement specifically requests that no reference be made. PLEASE READ CAREFULLY - By inserting my name (as written above) in the text field below, I certify that the above statements are correct. I understand that any false information (or omissions) in the application, or its supporting documents, will be sufficient grounds for refusal to hire me or termination without notice. I agree that all rules, orders, and regulations of the Board of Regents affecting my employment shall constitute a part of my appointment or employment. I further understand that Northwest Missouri State University has the right to review my education, previous employment, driving and criminal records and other background data.

Signed______

Northwest Missouri State University is an equal opportunity employer.

1 11/04/14