<p>University of Wisconsin-Madison APPLICATION FOR EMPLOYMENT AN EQUAL OPPORTUNITY EMPLOYER Classified LTE and Project Position Functioning under an Please complete all sections of this application Affirmative Action Plan</p><p>TITLE OF POSITION FOR WHICH YOU ARE APPLYING</p><p>NAME______(First) (Middle) (Last)</p><p>ADDRESS______Telephone (Work)______(Home)______No. & St. City Zip Code</p><p>SOCIAL SECURITY NUMBER______WISCONSIN RESIDENT? YES_____ NO_____</p><p>TYPE OF EMPLOYMENT YOU ARE SEEKING IF PART TIME, MINIMUM HOURS PER WEEK______MAXIMUM HOURS PER WEEK______(Check all types you will accept)</p><p>PROJECT_____ LIMITED TERM_____ FULL-TIME_____ PART-TIME_____ WEEKENDS_____ ROTATING SHIFTS_____</p><p>Day Shift (7:45-4:30)______Night Shift (11:00 pm-7:30 am)______Evening Shift (3:00 pm-11:30 pm)______</p><p>Education School Attended Location From To Graduation Date Course Major Degree Earned</p><p>High School ______xxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxx</p><p>Vocational School ______</p><p>Business College ______</p><p>College ______</p><p>Graduate School</p><p>Describe any education, training, or other experience you have had which is not covered above, such as correspondence course, military service, on the job training, apprenticeships, volunteer work, fluency in a foreign language, accounting, etc. Give dates. List any current licenses or registration as a member of a trade or profession.</p><p>The following information MUST be provided if you are applying for a position requiring typing or shorthand skills. Words Per Minute: Typing______Shorthand______</p><p>Do you have word processing experience? Yes_____ No_____ Do you have experience with personal computers? Yes_____ No_____</p><p>If yes, what kind of equipment/software (e.g. OfficeWriter, Lotus, Microsoft, etc)</p><p>List other office machines other than a typewriter which you can operate skillfully: WORK EXPERIENCES – PROVIDE A COMPLETE DESCRIPTION OF ALL QUALIFYING EXPERIENCE Start with your present or most recent job, include service in the armed forces and any self-employment. Indicate any change in job title under the same employer as a separate position.</p><p>PRESENT OR MOST RECENT EMPLOYER TYPE OF BUSINESS YOUR TITLE</p><p>FROM (MM/YY) TO (MM/YY) REASON FOR LEAVING OR CONSIDERING LEAVING AVERAGE HOURS PER WEEK</p><p>DESCRIPTION OF DUTIES Name, address & telephone of reference</p><p>PRESENT OR MOST RECENT EMPLOYER TYPE OF BUSINESS YOUR TITLE</p><p>FROM (MM/YY) TO (MM/YY) REASON FOR LEAVING OR CONSIDERING LEAVING AVERAGE HOURS PER WEEK</p><p>DESCRIPTION OF DUTIES Name, address & telephone of reference</p><p>PRESENT OR MOST RECENT EMPLOYER TYPE OF BUSINESS YOUR TITLE</p><p>FROM (MM/YY) TO (MM/YY) REASON FOR LEAVING OR CONSIDERING LEAVING AVERAGE HOURS PER WEEK</p><p>DESCRIPTION OF DUTIES Name, address & telephone of reference</p><p>May we contact employers for reference? Yes_____ No_____</p><p>I UNDERSTAND THAT ALL OF THE INFORMATION ON THIS APPLICATION IS TRUE AND COMPLETE, AND THAT ANY FALSE OR MISSING JOB RELATED INFORMATION MAY DISQUALIFY ME FOR THIS POSITION.</p><p>SIGNATURE______DATE______</p>