Student Center 2Nd Floor Facebook: Rvccareerservices Twitter: Rvccareers (815) 921-4100

Student Center 2nd floor | Facebook: RVCCareerServices | Twitter: @RVCCareers | (815) 921-4100 |

REQUIRED QUESTIONS
Are you applying for Summer semester? Yes No
Are you applying for Fall semester? Yes No
Are you applying for Spring semester? Yes No
Are you currently enrolled in 6 or more credit hours at RVC? Yes No
Have you been awarded Work-Study through financial aid? Yes No
(Only those students who have been awarded work-study are eligible for work-study student employment positions.)
If yes, what is your award amount (found on your Award Letter)? $
Please state your work availability:
Monday / Tuesday / Wednesday / Thursday / Friday
SAMPLE / 8am-12pm
4pm-6pm / N/A / 8am-12pm
4pm-6pm / N/A / 8am-12pm
4pm-6pm
Morning
Afternoon
Evening
PERSONAL INFORMATION
Full Name:
Have your academic or work records ever been under another name? Yes No
If so, please indicate:
Address: City: State: Zip Code:
Telephone Number: / Email Address:
Are you currently employed with RVC? Yes No If yes, please provide title and department:
HIGH SCHOOL or GED
Highest level completed: / Date Completed:
Name of High School:
ROCK VALLEY COLLEGE:
Major: / Minor: / Years, eg 1990-1991:
Type of Degree, if applicable: / Year Degree Conferred:

PREVIOUS EDUCATIONAL INSTITUTION:

Name of School: / City: / State:
Major: / Minor: / Years, eg 1990-1991:
Type of Degree, if applicable: / Year Degree Conferred:
EMPLOYMENT EXPERIENCE:
Employers Name: / Complete Address:
Supervisor’s Name: / Supervisor’s Telephone Number:
Base Salary: / Dates of Employment: / Title:
Brief Description of job duties:
Reason for Leaving: / May we contact this employer?
Employer’s Name: / Complete Address:
Supervisor’s Name: / Supervisor’s Telephone Number:
Base Salary: / Dates of Employment: / Title:
Brief Description of job duties:
Reason for leaving: / May we contact this employer?
Employer’s Name: / Complete Address:
Supervisor’s Name: / Supervisor’s Telephone Number:
Base Salary: / Dates of Employment: / Title:
Brief Description of job duties:
Reason for leaving: / May we contact this employer?
MILITARY SERVICE
Branch of Service: / Rank or Rate:
Date Entered: / Date Discharged:
CRIMINAL HISTORY:
Applicants are not obligated to disclose sealed or expunged records of conviction or arrest.
Have you ever been convicted of a crime or felony? Yes No
If yes, please indicate the offense, date, location:
REFERENCES:
Name: / Telephone:
Business, Profession, Title:
Name: / Telephone:
Business, Profession, Title:
Name: / Telephone:
Business, Profession, Title:

AGREEMENT:

I understand that the Campus Security Act (Public Act 88-629) requires public community colleges and universities to conduct criminal background investigations on all security sensitive personnel hired by the institution as determined by the Board of Trustees. Therefore, I understand that if I am hired, a criminal investigation of my background will be conducted and that my appointment shall be considered provisional, subject to successful completion of a criminal background investigation. I further understand that my employment may be terminated if the results of the criminal background investigation prove unsatisfactory in the opinion of Rock Valley College.

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for participation in the Student Employment Program as may be necessary in arriving at an employment decision. I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of Rock Valley College and the Student Employment Program.

By checking this box, I certify that I have read and agree with these statements.Today’s Date: