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Name: UCSB Student: Yes No
Phone:
Grad Date: Units/qtr:

GPA:
Email:

Address:




Which job/s are you applying for?

Are you eligible for work study?  Yes No

Have you ever been employed at UCSB?  Yes No


If yes, when and where?


Have you ever been convicted of a crime?  Yes No

If yes, please explain:
What date can you begin work?        # hrs/wk

Are you willing to work weekends?  Yes No

Over School Breaks?  Yes No

How did you learn about this position?

Please list most recent or current employment first.
Company: Employment Dates:
Address:
Supervisor: Phone: Last pay rate:

Reason for leaving:
 
Company: Employment Dates:
Address:
Supervisor: Phone: Last pay rate:

Reason for leaving:
 
Company: Employment Dates:
Address:
Supervisor: Phone: Last pay rate:

Reason for leaving:
 
Work shifts may begin at 6am and may end at 2am. Please indicate on the corresponding days what hours you are able to work.

Monday


Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

 
Please refer to the job description when answering the following questions.

1. Which skills mentioned in the job description do you possess?

2. List any relevant experience or skills and qualifications that you can
contribute to this position.

3. Why are you interested in this position?

4. List any additional relevant information.


Please click submit to send your application through our secure network!

Thank You!


  


 
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