application for employment
Matador Achievement Center, Dept. 10422
INSTRUCTIONS: Complete each section on both sides. Submit completed application along with a current resume. Incomplete applications will NOT be considered.
PERSONAL INFORMATION
Name: / Today’s Date:
Social Security #: / Student I.D. #
Local
Address: / City, ST, Zip:
Email: / Phone:
EMERGENCY CONTACT information / Contact’s Name: / ______
Relationship: ______/ Phone: / ______
Address: ______/ City, ST, Zip: / ______
EDUCATIONAL EXPERIENCE
Do you currently attend CSUN? / r yes
r no / major: / Cum. GPA:
Class Standing (circle one): / FR / SOPH / JR / SR / GRAD / Expected Graduation Date:
Are you or have you ever been a student-athlete at CSUN? / r yes r no / If yes, which sport?
AVAILABILITY

Day

/ Shift /

Hours You Are Available TO WORK within the Shift

/ total number of hours you prefer
to work each week:
Mon / 8:00am-9:00pm / (Potential hours/week = 1-20)
Tues / 8:00am-9:00pm / Minimum:
Wed / 8:00am-9:00pm / Maximum:
Thurs / 8:00am-9:00pm
SUN / 2:00PM-6:00PM

TUTORING SUBJECT-AREA(S)

List the course name and number for the classes in which you received a “B+” or higher and would be willing to tutor:
REFERENCES (Please include at least one CSUN faculty member)
nAME /

PHONE NUMBER

/ RELATIONSHIP(IF SUPERVISOR, INCLUDE COMPANY/ORGANIZATION)
1.) 
2.) 
3.) 

QUALIFICATIONS

Describe the qualities you possess and/or experience you have that qualifies you to motivate CSUN student-athletes to achieve academic success.
Applicant’s Signature: / Date:
For Departmental Use Only:
Reviewed by: / Date:
Hired: r no r yesà
/
start date:
/ /
job code:
/ /
class:
/ /
starting Pay rate:
/
Approved by: / Date:
ResponseS to Applicant:
Date / Type of Contact
(meeting, phone, email, etc.) / Comments
Comments:

shared file/m&t/forms/application updated 9/9/2016