* Are you or have you been employed by the University of Tennessee at Martin?   No Selection Yes No  

Are you receiving Financial Aid (mark all that apply)? College Work Study: Deanship Workship: Other:

* Mark the semester(s) you would be available for work: Fall: Spring: Summer:

Are you willing to work nights , weekends or overnights (11pm to 7am) ?

* How many hours per week are you willing to work?  

* Have you ever been convicted of a criminal offense or do you have criminal charges pending against you? (You may omit minor traffic violations or any offense committed before your 18th birthday, which was processed in a juvenile court.)

No Selection Yes No

If YES, explain:

* Skills: List any skills, training or other qualifications that you feel are applicable to the position for which you have applied, include all computer related skills:

* References: List three individuals, other than relatives, whom we can contact. They should have knowledge of your work experience and/or eductaion. (Former employers, supervisors, professors, colleagues, etc.)

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* Education :

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* Employment History :

May we contact? No Selection Yes No

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May we contact? No Selection Yes No

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May we contact? No Selection Yes No

What type of tasks would you be interested in performing (mark all that apply)?