CALIFORNIA STATE UNIVERSITY NORTHRIDGE

EMPLOYMENT APPLICATION
Mr. Last Name Student ID No. Mrs. Ms. Miss First Name E-mail Address Work Study Student Student Assistant M.I.

Local Address (Must provide a local address)

Street Address City/State/Zip Home Phone Cell Phone Apt. No. Street Address City/State/Zip

Permanent Address
Apt. No.

Permanent Phone

Emergency Contact
Name Name Relationship Relationship Phone No. Phone No.

Student Status
Major Class Level How many semester(s) do you expect to be attending CSUN? Present Course Load (units)

Skills
Typing wpm Computer Platforms: Computer Software MS-Word Excel List Additional Software Special Skills or Interests PC MAC Other

Work Experience
Are you currently working? Yes Have you ever worked on campus? Have you ever worked in a library? If yes, which library? Company Address/Location Duties Reference Reason for leaving Company Address/Location Duties Reference Reason for leaving No Yes Yes How many hours per week? No For Whom? (Dept) No Supervisor Name: Employment Dates

Employment History (List Most recent job first)

Phone No. Employment Dates

Pay Rate

Phone No.

Pay Rate

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I understand that if hired I must provide proof of my identity and work authorization as required by the Immigration Reform and Control Act of 1986. Notice: Students may not begin work until they have received the confirmation of Employment Form LSE-2 from Library Administration and have presented it to their supervisor. Date Yes No

Print Name Signature How many hours per week would you like to work in the library? Can you work weekends? Yes No

Can you work evenings?

Please place Xs in the squares below to block out hours you are NOT available to work. AM-PM 7-8 8-9 9-10 10-11 11-12 12-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 Supervisor please complete this portion upon hiring. Supervisors Name: Department: Start Date: Pay Rate: Classification: Mon Tue Wed Thurs Fri Sat Sun

Supervisor ID #: Dept. ID #: Job #:

FOR LIBRARY FINANCE & PERSONNEL OFFICE USE ONLY IRCA Verified Work Permit? Exp Date: LSE 1 Student Handbook Issued Work Study Requested SOLAR Entry MS Access Entry Revised 01/08/09