Clerical Assistant Employment Application

General Information

Date of Application: (mm/dd/yr)

Semesters that you wish to keep your application active (you must be enrolled):

Fall

Spring

Both Semesters

Personal Information

Student ID:
First Name:
Last Name:
M.I:

	Yes	No
Have you ever applied to Financial Aid for a Work Study Award?
Have you received Financial Aid for Work Study?

How many hours each week are you available?
School or College in which you are enrolled:

Major(s):
Minor(s):
Status:
Current GPA:

Contact Information

Street:
City:
State:
Zip:

Email:
Home Phone:	-
Times to Call:
Work Phone:	-
Times to Call:

Work Experience
(List most recent first)

Most recent position:


Postion	From	To

Agency or Firm	Supervisor

Address

Duties

Next most recent position:


Postion	From	To

Agency or Firm	Supervisor

Address

Duties

Next most recent position:


Postion	From	To

Agency or Firm	Supervisor

Address

Duties

References

Give at least three (3) references, such as professors or past employers, related to the subject(s) to be tutored or your working ability. We recommend that you have two letters of reference sent to us: Tutoring and Academic Resource Center, P.O. Box 413, Milwaukee, WI 53201. If possible, one letter should be from a professor in your preferred subject area.

Reference 1:


Name	Title

Address
-
Phone Number

Reference 2:


Name	Title

Address
-
Phone Number

Reference 3:


Name	Title

Address
-
Phone Number

Additional Comments

I hereby certify that the above is true, that this department may contact any of the above listed references, and that a UWM transcript may be released to the Department.

Input your name here if you agree to the above statement: