NDSU CNSE Application for Hourly Employment 1

1805 NDSU Research Park Drive, Fargo, ND 58102

APPLICATION FOR HOURLY EMPLOYMENT

PERSONAL INFORMATION Date:

Name

LAST FIRST MIDDLE

Local Address

STREET APT

CITY STATEZIP

Phone Number ( ) - - E-mail Address

EMPLOYMENT DESIRED


Position(s) / Date You
Can Start / Desired
Salary / hr.

Desired Hours per Week:

Are you If so, may we contact

currentlyemployed? YesNo your present employer? YesNo

Can you provide proof, if hired,

that you are eligible to work in the United States? YesNo

EDUCATION AND TRAINING

Name and Location of School / Last Year Completed / Graduation Date / Major / Area of Study / Degree
High School / 1 2 3 4
College / 1 2 3 4
Trade, Business or
GraduateSchool / 1 2 3 4

Subjects of Special Study, Relative Course Work, or Research Work

Other Job Related Skills

EMPLOYMENT HISTORY

Current or Most Recent Employer Name and Address

Supervisor’s Name

Phone Number

Position Title Reason for Leaving

Start Date End Date

Beginning Wage Ending Wage

Responsibilities

Previous Employer Name and Address

Supervisor’s Name

Phone Number

Position Title Reason for Leaving

Start Date End Date

Beginning Wage Ending Wage

Responsibilities

Previous Employer Name and Address

Supervisor’s Name

Phone Number

Position Title Reason for Leaving

Start Date End Date

Beginning Wage Ending Wage

Responsibilities

REFERENCES

Name / Address / Phone Number / Relationship

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.

I understand that prior to my employment, the NDSU Criminal Record Disclosure Form must be signed and submitted.

Upon employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand that I am required to abide by all rules and regulations of NDSU-CNSE.

Signature of Applicant Date

Thank you for your interest in employment opportunities at the NDSU - Center for Nanoscale Science and Engineering.

Please complete all sections on the employment application. A resume may be included to supplement your application. Do not substitute your resume for the information requested on the application.

Submit completed application to:CNSE HR/Payroll Specialist

NDSU - Center for Nanoscale Science and Engineering

1805 NDSU Research Park Drive

Fargo, ND58102

or electronically to the application is submitted electronically, the corresponding e-mail is

substituted as the signature for the disclaimer.

For more information on positions, visit our website at call (701) 231-5824, or send an e-mail to .

FOR CNSE USE ONLY

Was Applicant Selected for an Interview?YesNo

Interviewed By Date

REMARKS:

Before offer is made, an approval from the director must be received. Return application to CNSE HR/Payroll at completion of search.

SelectedNot Selected

If Selected

SupervisorWork Room / LabPosition Funding

Start DateHourly Wage

NDSU is an Equal Opportunity Employer