SLIPPERY ROCK UNIVERSITY

GRADUATE ASSISTANTSHIP EMPLOYMENT APPLICATION

When completed, this form should be sent to the department/office in which you wish to apply for employment.

*Students who have over 6 credits of undergraduate competencies are not eligible for a GA position*

Name:
Banner ID#: A00______

Present Address:

Home Phone:
Work Phone:

Email Address:

______

Graduate Assistantship Position Desired:

When Available to Begin Work?

______

EDUCATIONAL BACKGROUND

From
Month/Year
/ To
Month/Year
/ Institution and Location
/ Major
/ Degrees, if any
/ Date Granted
Month/Year
/ Credit Hours
Completed

If you are currently engaged in a program of higher education, what is your present status?

Other training, specialized skills or qualifications, licenses:

What graduate program of study are you enrolled in or applying to at SRU?

Will you be taking classes at SRU full-time or part-time?

Have you previously had a graduate assistantship at SRU? Yes No If so, for how many semesters?

PERSONAL BACKGROUND______

Are you a U.S. Citizen? Yes No

If not, are you legally eligible to accept employment in the U.S.? Yes No

Please explain

______

*Within the last five years, have you been fired for any reason or have you quit a job after being notified that you would be fired? Yes No

*Note: If you answer yes, on a separate sheet of paper, give all facts. Show name and address of employer, approximate date and reason in each case. Being fired from a position does not mean you cannot be appointed. The nature of firing and how long ago it occurred are important.

______

Were you ever convicted of a criminal offense, or have you ever forfeited bond or collateral in connection with a criminal charge? Yes No

Omit 1.) Minor traffic violation; 2.) Any offense committed before your eighteenth birthday, which was finally settled in a juvenile court or under a youth offender law. Conviction of a criminal offense is not a bar to employment in all cases: Each case is considered on its merits. If yes, give details on a separate sheet of paper. (Be sure to include your social security number.)

______

If you are applying for a position that requires a driver’s license, do you possess a current Pennsylvania driver’s license? Yes No

______

Do your records appear in any name(s) other than the name listed above? If so, please list name(s).

EMPLOYMENT HISTORY (Begin with present or most recent, employment. Add additional pages, if needed.)

A. Name and address of employer / Dates Employed (MM/YYYY)
From: / To:/ / Avg. Number of Hrs. Per Week
Salary Or Earnings
Beginning $ Per
Ending $ Per / Your Reason for Leaving
Title of your position / Name and Title of Immediate Supervisor / Phone Number
Description of duties:
B. Name and address of employer / Dates Employed (MM/YYYY)
From: / To: / / Avg. Number of Hrs. Per Week
Salary Or Earnings
Beginning $ Per
Ending $ Per / Your Reason for Leaving
Title of your position / Name and Title of Immediate Supervisor / Phone Number
Description of duties:
C. Name and address of employer / Dates Employed (MM/YYYY)
From: / To: / / Avg. Number of Hrs. Per Week
Salary Or Earnings
Beginning $ Per
Ending $ Per / Your Reason for Leaving
Title of your position / Name and Title of Immediate Supervisor / Phone Number
Description of duties:

*Please attach a current resume to this application

REFERENCES______

List 3 persons (at least one of whom is a former or present employer if you are or have been employed) who have knowledge of your work experience and/or education. By listing these, you authorize the University to contact said persons for a reference on your behalf and also authorize them to release information on your behalf.
/ / () - ext.
Name / Address / Phone

/ / () - ext.

Name / Address / Phone

/ / () - ext.

Name / Address / Phone

I certify that all of the statements made by me on this form are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I understand that provision of false or misleading statements may subject me to criminal prosecution and may subject me to termination of any employment gained pursuant to this document.

______
Signature of Applicant Date