<p> SERVICES TO STUDENTS WITH DISABILITIES California State University, Sacramento</p><p>STUDENT JOB APPLICATION P l e a s e p r i n t c l e a r l y a n d c o m p l e t e b o t h s i d e s i n i n k NAME ______DATE _____/_____/_____ (LAST) (FIRST) (MI)</p><p>ADDRESS______Sac State ID _____-_____-______(STREET) (APT #)</p><p>CITY/STATE______ZIP______PHONE (home) (____)______</p><p>E-MAIL______PHONE (other) (____)______</p><p>APPLYING FOR: ____ READER ____ NOTETAKER ____ TUTOR (specify course according to job announcement) ______OTHER (specify position according to job announcement) ______</p><p>EDUCATION</p><p>UNIVERSITY/COLLEGE: CSUS__ OTHER__ GPA: MAJOR______OVERALL_____</p><p>STATUS: GRAD ____ UNDERGRAD ____ 1st YR_____ 2nd/3rd YR_____ 4th YR or more____</p><p>Anticipated graduation date: ______</p><p>AREAS OF STUDY: UNDERGRADUATE MAJOR______MINOR______</p><p>GRADUATE (if applicable)______</p><p>EMPLOYMENT</p><p>LIST ANY CURRENT ON-CAMPUS SAC STATE EMPLOYMENT </p><p>Department ______Job title: ______</p><p>Hours per Week______As of month______year______</p><p>LIST ANY EXPERIENCE RELATED TO THE POSITION (i.e., reading, notetaking, experience with people with disabilities): ______</p><p>______</p><p>______PROVIDE TWO PROFESSIONAL REFERENCES (Employment or Academic)— REQUIRED ! NOTE: In-state referrals are recommended</p><p>APPLICANTS MUST COMPLETE THE ATTACHED AVAILABILITY SCHEDULE.______Rev 8/07 SERVICES TO STUDENTS WITH DISABILITIES California State University, Sacramento</p><p>STUDENT JOB APPLICATION P l e a s e p r i n t c l e a r l y a n d c o m p l e t e b o t h s i d e s i n i n k Name______Title______Phone ( ) ______</p><p>Name______Title______Phone ( ) ______</p><p>AREAS/SUBJECTS</p><p>I WOULD BE BEST SUITED AT WORKING WITH STUDENTS IN THE FOLLOWING AREAS/SUBJECTS:</p><p>______TECHNICAL (i.e., Math, Physics) ______LITERARY (Novels) ______HISTORICAL/THEORETICAL </p><p>______OTHER (Specify) ______ANY OF THESE </p><p>I WOULD LIKE TO TUTOR IN THE FOLLOWING SUBJECTS OR COURSES IN WHICH I HAVE RECEIVED A MINIMUM GRADE OF “B+”:</p><p>COURSE GRADE AUTHORIZED SIGNATURE OF DEPT. CHAIR**</p><p>1)______</p><p>2)______</p><p>3)______</p><p>**Transcripts may be provided in lieu of Dept. Chair Signature. If no transcript provided, and course completed at Sac State, your signature on this application indicates authorization to access Sac State records.</p><p>SKILLS/INTEREST</p><p>INDICATE APPLICABLE SKILLS OR EXPERIENCE (SUBJECT TO VERIFICATION): BRAILLE____ SIGN LANGUAGE_____ TEST PROCTOR_____ TUTORING_____ </p><p>INDICATE WHY YOU ARE INTERESTED IN THIS POSITION: ______</p><p>______</p><p>______</p><p>PLEASE PROVIDE ANY ADDITIONAL COMMENTS OR INFORMATION ABOUT YOUR SKILLS OR ABILITIES TO PERFORM THIS TYPE OF WORK: ______</p><p>______</p><p>I CERTIFY THAT ALL INFORMATION ON THIS APPLICATION IS CORRECT, AND THAT I HAVE ANSWERED ALL QUESTIONS TRUTHFULLY. I UNDERSTAND THAT FAILURE TO COMPLETE ALL SECTIONS OF THE APPLICATION MAY LEAD TO AN UNPROCESSED APPLICATION.</p><p>______</p><p>APPLICANTS MUST COMPLETE THE ATTACHED AVAILABILITY SCHEDULE.______Rev 8/07 SERVICES TO STUDENTS WITH DISABILITIES California State University, Sacramento</p><p>STUDENT JOB APPLICATION P l e a s e p r i n t c l e a r l y a n d c o m p l e t e b o t h s i d e s i n i n k APPLICANT’S SIGNATURE DATE</p><p>APPLICANTS MUST COMPLETE THE ATTACHED AVAILABILITY SCHEDULE.______Rev 8/07</p>