The University of Wyoming Application for Non-Benefited Temporary Employment

Human Resources Department / Phone: (307) 766-2215
Room 139, Wyoming Hall / Fax: (307) 766-5607
1000 E. University Ave. / TDD: (307) 766-2216
Dept. 3422 / http://www.uwyo.edu/hr

Laramie, Wyoming 82071

The University of Wyoming is an Equal Opportunity Affirmative Action Employer
Name
(Print) / (Last) / (First) / (Middle) / Telephone Number
Address / E-mail Address
Are you a U.S. citizen or currently authorized to work in the United States on a full-time basis? / Yes / No
Have you ever been convicted of or pled guilty or nolo contendere/no contest to any felony? / Yes / No
If yes, please explain:
If the answer above is yes, you must provide a certified copy of conviction and any other pertinent, clarifying documents to the Human Resource Department.
Have you ever been convicted of or pled guilty or nolo contendere/no contest to a sex crime against a minor or a sex crime involving violence? / Yes / No
If yes, please explain:
If the answer above is yes, you must provide a certified copy of conviction and any other pertinent, clarifying documents to the Human Resource Department.
Date Available for Employment / Number of Hours Work Desired Per Week
Current UW Employee? / If Yes Where?
Hours Available for Work / Skills/Licensure (Please check if proficient/trained in)
Monday / Typing (wpm) / Calculator / Custodial
Tuesday / Computer / Cashier / Foreign Language
Wednesday / Word Processing / Bookkeeping/Acct. / Valid Driver's License
Thursday / Spreadsheet / Phone/Reception / OTHER
Friday / Database / Sales
Saturday / Data Entry / Food Service
Sunday / Graphics / Library
List your employers, starting with your current or most recent employer. Please indicate any previous UW employment. It may be helpful to attach a resume. You may also include volunteer experience.
Current/Last Employer: / Dates Worked:
City/State: / Reason for Leaving:
Position Title:
Major Duties/Activities:
Employer: / Dates Worked:
City/State: / Reason for Leaving:
Position Title:
Major Duties/Activities:
I certify that all information given on this application, supporting documents, and interviews are correct to the best of my knowledge. I understand that giving false information may disqualify my application or result in termination. I understand that this application is not intended to be a contract of employment. I authorize the university to investigate all statements made on my application for employment. I authorize such educational institutions and employers and others (and their agents or employees) to respond to questions concerning information given on this application and I further release from liability the University of Wyoming, such former employers, institutions, or persons providing such information. I understand that no salary rate is final until approved by the Human Resources Department. Federal law requires employers to document the identity and employment authorization of each new employee.
Signature / Date

If you are a person with a disability and need an accommodation for the application/interview process, please call 307-766-2215.

Updated 07/25/07