Western Michigan University
Residence Life Student Staff Application
Applications are due January 17, 2003 by 5pm
to the Office of Residence Life- 3510 Faunce Student Services Building
***Please print or type***
General Information:
Name: ______________________________________ ID #________________________________
Local Address: ___________________________________________________________________
Local Phone #:____________________________________________________________________
Permanent (Summer) Address: _______________________________________________________
Permanent (Summer) Phone #________________________________________________________
Email Address: ___________________________________________________________________
Would you object to living in a smoking environment? Y N
How many semesters have you lived in WMU’s residence halls (include current semester)? ______
Have you attended any other colleges/universities other than WMU? If yes, please list.
_______________________________________________________________________________
Did you live in their residence hall system? Y N
If yes, how many semesters? _________________________________________________
Have you ever been found responsible for violating the Student Code? Y N
If yes, please explain: _______________________________________________________
Have you ever been convicted of a felony or misdemeanor (other than minor traffic violations)? Y N
If yes, list date, charge, location, court, and action taken: ___________________________
_______________________________________________________________________________
Academic Information:
Major: ______________________________________ Overall GPA: ___________________
Expected Graduation Date: ______________________ Class Standing FR SO JR SR OTH
Work/Extracurricular Information:
List dates, supervisors and telephone numbers.
Previous Work Experiences:
Date Position Title Supervisor Telephone Number
References:
Current/Most Recent Residence Life Staff Member:
__________________________________________________________
(Name) (Position) (Phone Number)
Second Reference (Does not have to be a Residence Life staff member)
__________________________________________________________
(Name) (Position) (Phone Number)
Building Preference:
Although we reserve the right to place you where we can best use your talents, please rank (with 1 being your first choice) your assignment preferences below.
___ Valleys (Please rank each valley)
___ Valley I: Ackley/Shilling, Britton/Hadley
___ Valley II: Eicher/LeFevre, Garneau/Harvey
___ Valley III: Harrison Stinson, Eldridge/Fox)
___ Little 3 (Zimmerman/French/Davis)
___ Big 3 (Hoekje, Bigelow, Henry)
___ Big 4 (Burnhams, Draper/Siedschlag)
___ No Preference
In have read the job description. I am aware of the department expectations and university rules and regulations and will abide by them as detailed if I am offered and accept a staff position. I certify that all of the information disclosed on this application is true and accurate and that any misrepresentation of facts may constitute cause for non-appointment or dismissal. I understand that as a condition of this application, my GPA, conduct records, and all past or current supervisors or Residence Life staff members may be contacted. I understand that employment at the University is conditional upon review of my criminal conviction records. I authorize the University to request and obtain, through the Michigan State Police, an investigation and report to determine the accuracy of my above answers about prior criminal conviction. Employment agreements are issued on a yearly basis and appointing officials are not obliged to extend employment for additional time based on performance review.
Applicant Signature ___________________________Date: ___________________
Involvement
Please answer the following questions to the best of your ability. Please include dates and position titles when appropriate. You may use the back of this page if you need more room.
***Please print or type***
1. Please list any previous extracurricular activities, including leadership experience.
(examples: RHA, WSA, Student Organizations, Greek Organizations, Hall Involvement, etc.)
2. Please list any volunteer experience.
(examples: Red Cross, Big Brothers/Big Sisters, Fall Into the Streets, ASB, AWB, etc.)
3. Please list any previous job related experience that may relate to the RA position.