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Application for student Employment

Date: 2009-11-23

Jobs Listing

* Required Fields

Job(s) applying for:

Applicants may apply for a maximum of 5 positions.

PERSONAL INFORMATION

Name:

* Last/Family Name	* First/Given Name	Middle Initial	Preferred Name
Permanent Address:

* Street	* City	* State	* ZIP
* Permanent Phone:
Local Address (if different from permanent address):

Street	City	State	ZIP
* Local Phone:

If a student, Unity ID:		Email address:

EQUAL OPPORTUNITY INFORMATION -- VOLUNTARY DEMOGRAPHIC DATA

Equal Opportunity information is VOLUNTARY.

Discrimination on the basis of race, sex, color, creed, religion, national origin, age, disability or veteran status is prohibited at NC State University. Sex or age or absence of a disability may be a bonafide occupational requirement in a small number of jobs. The information requested below will not affect you as an applicant. The information will be retained to ensure that the University's recruitment efforts are reaching all segments of the population.

NC State University regards discrimination of the basis of sexual orientation to be inconsistent with its goals of providing a welcoming work environment in which all of its students, faculty, and staff may learn and work up to their full potential. The University values the benefits of cultural diversity and pluralism in the academic community and welcomes men and women of good will without regard to sexual orientation.

Gender:

Female

Male

Do Not Wish To Disclose

Ethnic Group:

White
Black / African American (non-Hispanic)
Hispanic / Latino
Asian
American Indian
Hawaiian or Pacific Islander
Do Not Wish To Disclose

Date of Birth:

Year:

GENERAL INFORMATION

* Do you have a work study award?
No	Yes		If Yes, list the amount per semester.

			$	$	$	$
			Fall	Spring	SS I	SS II

* Are you now employed or have you ever been employed by the NCSU Libraries?
No	Yes	If Yes, list department, dates, and name used (if different from above).

* Have you ever been convicted of an unlawful offense other than a minor traffic violation?
No	Yes	If Yes, please explain. (A "Yes" will not automatically disqualify you.)

AVAILABILITY

Date available to start work: (mm/dd/yy)
Number of hours/week you wish to work?

Many jobs can be scheduled to meet your needs.

When are you available to work?

	Morning	Afternoon	Evening	Overnight	Time you are available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

EDUCATION

* Did you graduate from high school?	No Yes
* Did you graduate from college?	No Yes
Type of degree:
* Did you graduate from graduate school?	No Yes
Type of degree:

* Are you now a student?	No Yes
If a student, are you part or full time?	Part time Full time
If a student, what type?	Undergraduate Graduate Other
If a student, what is your major field of study?

SKILLS

Areas in which you have training or experience. Check all that apply.

Audio/Visual Equipment
Bookkeeping/Accounting
Customer/Public Service
Data Entry/Keyboard
General Office
Heavy Lifting
Photocopy Equipment
Computing Skills - applications, programs, and languages:

Languages other than English - list language(s):

Other - list:

EMPLOYMENT/VOLUNTEER WORK HISTORY
List most recent employer first.

Employer:
Address:

Date Employed (mm/yy):
Date Separated (mm/yy):

Supervisor's Name:
Telephone Number:

Reason for Leaving:	Duties:
Other comments:

Employer:
Address:

Date Employed (mm/yy):
Date Separated (mm/yy):

Supervisor's Name:
Telephone Number:

Reason for Leaving:	Duties:
Other comments:

Employer:
Address:

Date Employed (mm/yy):
Date Separated (mm/yy):

Supervisor's Name:
Telephone Number:

Reason for Leaving:	Duties:
Other comments:

North Carolina State University is dedicated to equality of opportunity within its community. Accordingly, North Carolina State University does not practice or condone discrimination in any form against students, employees, or applicants on the grounds of race, color, national origin, religion, sex, age, or handicap. North Carolina State University commits itself to positive action to secure equal opportunity regardless of those characteristics.

I certify that I have given true, accurate and complete information on this form and any supplements. I authorize educational institutions, associations, registration and licensing boards and others to furnish whatever detail is available concerning my qualifications. I authorize investigation of all statements made in this application and I understand that false information or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action or dismissal if I am employed, and/or criminal action/ I further understand that dismissal upon employment shall be mandatory if fraudulent disclosures are given to meet position qualifications. Not withstanding any provision of State or Federal law, I expressly waive any right I may have to review material or information received from a previous employer or educational institution under promise of confidentiality.