Kansas State University

Personal Information

Full Name:

K-State E-mail:

Phone #:

Local Address (Optional):

Permanent Address:

Preferred Address Permanent Address Local Address

Academic Information

Major:

Classification: Freshman Sophomore Junior Senior Graduate

Expected Graduation Date: May August December 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 2045 2046 2047 2048 2049 2050 2051 2052 2053 2054 2055 2056 2057 2058 2059 2060 2061 2062 2063 2064 2065 2066 2067 2068 2069 2070 2071 2072 2073 2074 2075 2076 2077 2078 2079 2080 2081 2082 2083 2084 2085 2086 2087 2088 2089 2090 2091 2092 2093 2094 2095 2096 2097 2098 2099 2100 2101 2102 2103 2104 2105 2106 2107 2108 2109 2110 2111 2112 2113 2114 2115 2116 2117 2118 2119 2120 2121 2122 2123

Number of Credit Hours Currently Enrolled:

General Information

Are you eligible to work in the U.S.? Yes No

Do you have a valid driver's license? Yes No

What languages can you speak, read or write?

Work Availability & Scheduling

This section is an approximation of your work availability

Mark boxes that correspond to your preferred preliminary work schedule.

Schedule Applies to: Fall Spring Summer

Can you work during the summer? Yes No

Can you work holidays and breaks? Yes No

Hours you expect to work per week: 12-15 15-18 18-21 21-24 24-27 27-30

Preferred Start Date:

Position Applying for: Technician Customer Service

Scheduling Notes

• Student staff may work a maximum of 30 hours per week.
• Staff must be able to work a minimum of 12 hours per week.
• Shifts must be at least 2 hours in length.
• Mandatory breaks are scheduled for shifts longer than 5 hours.

Employment History

Employer 1

Employer:

Position Title:

Employer Address:

Description of Duties:

Reason for Leaving:

Dates Employed

From:

To:

Supervisor Name:

Supervisor Phone #:

Supervisor E-mail:

May we contact your supervisor? Yes No

Employer 2

Employer:

Position Title:

Employer Address:

Description of Duties:

Reason for Leaving:

Dates Employed

From:

To:

Supervisor Name:

Supervisor Phone #:

Supervisor E-mail:

May we contact your supervisor? Yes No

References

Reference 1

Name:

Phone #:

E-mail:

Relationship:

Reference 2

Name:

Phone #:

E-mail:

Relationship:

Reference 3

Name:

Phone #:

E-mail:

Relationship:

Related Experience

Please evaluate your familiarity on a scale of 4-Very, 3-Moderately, 2-Slightly, or 1-Not Familiar

Please provide any additional relevant skills, qualifications or comments. (Optional)

To the best of my knowledge, all answers to the foregoing are true and correct. I hereby grant permission to Kansas State University to contact each of my former employers listed above concerning my qualifications for employment. Permission is also granted to each of my former employers to give Kansas State University information they may have with respect to my work experience with them. I understand that falsifying information on this application may be grounds for dismissal. Date and Sign below if you agree to this statement. Digitally signing this document locks all fields.

Date:

Signature:

Please send a resume with this application. Applying for a position does not guarantee an interview.

Cover Letter:

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