Application
For:
FALL
Date: ________________
(Fill in
Year)
SPRING
SUMMER
Name:_________________________________________
SS#:
Last
First
M.I.
Local Address
(CS
Box):
Phone:
Permanent
Address:
Phone:
Class Standing:
FR SO JR
SR GRAD
Student Status: Full
Time
Part Time
Expected
Graduation Date:
U.S.
Citizen:
Y
N
VISA Type:
Are you receiving financial aid or assistance:
Y
N
If yes, indicate
type:
Work Study
Graduate Assistant
Loan
Scholarship/Grant
EMPLOYMENT HISTORY
Previously Employed by Rec Sports:
Y
N
Position:
Date(s):
Pay Rate:
Previously Employed by W&M:
Y
N
Department:
Date(s):
Pay Rate:
PREVIOUS WORK EXPERIENCE
1. Place Of
Employment
Phone:
Position:
Date
Started:
Date Ended:
Supervisor:
2. Place Of
Employment
Phone:
Position:
Date
Started:
Date Ended:
Supervisor:
3. Place Of
Employment
Phone:
Position:
Date
Started:
Date Ended:
Supervisor:
POSITION DESIRED
Office
Assistant
Outdoor Recreation Center
Office
Manager
W&M Hall Supervisor
Facility
Supervisor*
Fitness Instructor***
Lifeguard**
IM Sports Supervisor*
IM Sports
Official
Other
* Facility and Sports Supervisors are required to obtain and update current Adult CPR and First Aid Certifications. (Certification provided by Recreational Sports)
** Lifeguards are required to have current Lifeguarding, Adult CPR, and First Aid Certifications. (Recreational Sports will provide CPR and First Aid only).
*** Fitness Instructors are required to obtain and update current Adult CPR and First Aid Certifications. (Certification provided by Recreational Sports). Fitness Instructors are required to audition and demonstrate Fitness Instruction Skills.
CPR
Exp.
Date:
Received From:
FIRST
AID
Exp.
Date:
Received From:
LIFEGUARDING Exp.
Date:
Received From:
FITNESS CERT. Exp.
Date:
Received From:
OFFICE USE ONLY:
Name: ________________________ Application Date:
Hired: Y N Reason Not Hired:
Position: ID OM FS FI FA OA ORC SS SO LG
Rate: Effective Date: Completed Payroll Paperwork:
HISTORY
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Date Employment
Ended:
Reason: