Name Date
Address
City
State Zip Phone Birth Date
eMail

Are you currently enrolled at a community college, college or university? | Yes | No |
Name of institution Credit hours enrolled for

If NO, were you enrolled at a community college, or university last term?| Yes | No |
Name of institution Credit hours enrolled for

Are you currently employed elsewhere? | YES | NO | Number of hours per week
Name of current employer

Please provide us with the number of hours per week you'd like to work for Campus Recycling:
Preferred minimum Maximum hours

Grade level Major Minor
Student Employment Financial Aid Award (select one): Federal Work Study UO Work Study None

CAPABILITIES
Are you a licensed driver? | Yes | No | License # State of issue
Describe any experience you have driving large vehicles:

Are you able to lift 50 pounds? | Yes | No |
Describe any experience you have lifting/handling such materials:

Describe any prior involvement you've had in community or campus activities, student government,
or other student or volunteer programs which may be relevant to this position:

What do you know about Campus Recycling at the U of O?

Why are you interested in working for Campus Recycling? What do you hope to gain?

Provide any additional experience or information about yourself which you feel might represent
a valuable contribution to the program or otherwise qualify you for employment with us:

EMPLOYMENT HISTORY
Please list your work experience below, beginning with your most recent or current position:
Employer Address
Supervisor name: Supervisor title:
Your position: Your title:
Dates employed: | FROM: TO: Hours per week

Employer Address
Supervisor name: Supervisor title:
Your position: Your title:
Dates employed: | FROM: TO: Hours per week

Employer Address
Supervisor name: Supervisor title:
Your position: Your title:
Dates employed: | FROM: TO: Hours per week

REFERENCES:
Please list the names of and contact info for persons who can comment upon your abilities and personal characteristics:
1. Reference name
Relationship Phone number

1. Reference name
Relationship Phone number

1. Reference name
Relationship Phone number

By checking this box
I certify that all information and statements on this application are true to the best of my knowledge.
Name Date

COMPLETE THE "SCHEDULE OF AVAILABILITY"