University of Southern Maine

*Attention: Please use the TAB key to move from field to field. DO NOT use the ENTER or RETURN key.

Name

Address

City State Zip

Phone

Email

1.Do you have Federal Work-Study Money? Yes No Don't Know

If Yes, what is the amount of your workstudy award?

2. Are you in a degree program? Yes No

3. What is your program major?

4. Class Rank Freshman Sophomore Junior Senior Grad

5. Were you previously employed in a work-study position? Yes No

When? Where?

6. What are your career goals?

7. Which of the work-study employment sites do you prefer?

8. What are your reasons for preferring these employment sites?

9. What skills do you have that might be used in your preferred employment?

10. Have you taken a computer course? Yes No

11. Office & Other Experience:

Word Processing Filing Customer Service

Spreadsheet Answering Phones Photocopying

Duplex Collating Binding Machine

Fax Machine Cash Register

12. What other strengths do you have that might be of interest to an employer?

13. How many hours per week are you available for Work Study employment?

14. What hours are you able and willing to work? Click Here for Department Hours

Available Hours:

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Class Schedule

Monday
Tuesday
Wednesday
Thursday
Friday

15. Is there any other information about yourself you would like a prospective Work-Study employer to know?

16. Please list 3 persons who could serve as employment-related references:

Name Phone

Name Phone

Name Phone