Wage Payroll Application Form (All fields must have a value!)

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       Job Information:

Semester:

Select One Fall 2009

Type of job:

Select One Grader Lab Assistant Stockroom Assistant Department Helper (work study)

Course (for Grader):

Select One EE 477 EE 474 EE 471 EE 460 EE 442 EE 438 EE 421 EE 420 EE 320 EE 311 EE 310 EE 210

Course (for Lab Assistant):

Select One EE 316 EE 310 EE 210

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       Personal Information:

First Name:

Last Name:

Student Number:

E-mail Address:

Local Phone Number:

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       Academic Information:

Undergraduate or Graduate:

Select One Graduate Undergraduate

Cumulative GPA:

Major:

Are You A Full Time Student (undergrad> 11 cr, grad>8 cr):

Are you receiving any type of assistantship or fellowship:

Select One Yes No

Are you an international student:

Select One Yes No

Do you have a work study grant:

Select One Yes No

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       Relavent Job Information:

Have you held this position before:

Select One Yes No

	List any experience that may qualify you for this position:

How many hours do you wish to work (up to 20 per week):

	Click on class times and other times you CANNOT work:
	Period Monday Tuesday Wednesday Thursday Friday 1 2 3 4 5 6 7 8 9