Florida Gulf Coast University s1

Florida Gulf Coast University OFFICE OF ADAPTIVE SERVICES Federal Work Study Position Application Fall 2015-Spring 2016

Name: ______Date of application: ______Address: ______

Phone: Daytime: (_____) ______Other Phone: (_____) ______Email: ______

Current College GPA: ______

College Major: ______

Please list any previous FGCU work experience: ______

Please list any computer programs you have worked with including any Microsoft Office programs: ______

Have you ever worked with individuals with disabilities? ______

Please list any experience with accommodations (i.e. test proctoring, note-taking, reading, and scribing, etc.): ______

Semester you intend to graduate: ______, 20__ .

Have you ever been convicted of, pled guilty to, or pled nolo contendre (no contest) to a felony or legal offense that would influence your ability to perform in this agency? (Example: sexually-based offenses, drug or alcohol offenses, domestic violence, or similar) ______

.Have you ever had any disciplinary action taken against you for being in violation of ethical/legal standards of practice by a graduate or internship training program, practicum site or employer? Have you ever been sanctioned for any policy violation at FGCU? Please explain. Answering yes to this question does not automatically disqualify you from working at Adaptive Services. ______

(Continued following page) With your application, please include:  A curriculum vita (a resume that includes a list of courses taken; employment and/or internship experiences; volunteer work; etc)  Three professional references that we may check

Bring your completed application to the Adaptive Services office in Howard Hall rm. 137 or mail to:

The Office of Adaptive Services 10501 FGCU Boulevard South Ft Myers, FL 33965-6565

APPLICATIONS ARE DUE BY AUGUST 10, 2015