Appalachian State University s6

OFFICE USE ONLY APPALACHIAN STATE UNIVERSITY Date Received: UNIVERSITY RECREATION ______Application for Employment Date Emailed: ______Date of Application: Active Until: Position applying for: ______

Please Circle the Semester Applying for: Fall Spring Summer#1 Summer#2

I. PERSONAL INFORMATION Name: Last First Middle

E-Mail Address: ASU Box Number:

Permanent Address: (Parent’s Address) Telephone #: ( )

Street & Apt. # / P.O. Box:

City / State / Zip Code:

Local Address: Local Telephone #: ( )

Street & Apt. # / Residence Hall and Room #:

City / State / Zip Code:

Classification: FR__ SO__ JR__ SR__ Grad.__

Major: Expected Graduation Date:

Please list any injury, illness or medical condition, which might require treatment:

II. WORK EXPERIENCE:

Position Company/Organization Length of Employment Supervisor:

Phone:

III. CERTIFICATION(S): (i.e. CPR, First Aid, Group Fitness, Personal Training . . .):

***PLEASE ATTACH RESUME IF AVAILABLE OR A LIST OF QUALIFACATIONS AND REFERENCES (including email address) Name: Date:

Minimum # of hours you are requesting: Maximum # of hours you are requesting:

The following availability is for (Please Circle): Fall Spring Summer#1 Summer#2

Please check the times below that you ARE AVAILABLE to work each day:

Time Mon Tue Wed Thu Fri Sat Sun 5:30 am 6:00 am 6:30 am 7:00 am 7:30 am 8:00 am 8:30 am 9:00 am 9:30 am 10:00 am 10:30 am 11:00 am 11:30 am 12:00 pm 12:30 pm 1:00 pm 1:30 pm 2:00 pm 2:30 pm 3:00 pm 3:30 pm 4:00 pm 4:30 pm 5:00 pm 5:30 pm 6:00 pm 6:30 pm 7:00 pm 7:30 pm 8:00 pm 8:30 pm 9:00 pm 9:30 pm 10:00 pm 10:30 pm 11:00 pm 11:30 pm 12:00 am 12:30 am