Application Date:

Month January February March April May June July August September October November December Year 2007 2008

Personal Data:

First and Last Name

E-mail Address

Campus Address

CMR

Campus Phone Number (if applicable)

Class Year

Year 2008 2009 2010 2011

Date Of Birth

Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982

Have you ever interviewed with us?

Y/N Yes No

If yes, when?

Month January February March April May June July August September October November December Year 2008 2007 2006 2005 2004

References:

Please list 3 on-campus references.

Specify name, address, and phone number for each. Include at least one faculty member

Reference 1:

Reference 2:

Reference 3:

Employment Data:

Are you receiving Work Study Assistance? Y/N Yes No

Have you worked on campus before? Y/N Yes No
If so, where and when?

Are you working elsewhere (on or off campus) this semester? Y/N Yes No
If so, where and when?

Technical Skills:
Educational Technologies Student Staff provide one-on-one and group training to clients. Describe any technical (hardware and/or software) skills that might be useful for this position:

Personal Skills:
Customer service skills are essential to our Educational Technologies Student staff. Describe any experiences, work or otherwise, that have helped you to develop your "people skills".

Other Information:
Please describe any further experiences, knowledge or personal qualities you feel qualify you for this position: