Federal Work-Study Application Form

Personal Information

First Name: *

Last Name: *

Address:

City:

State:

Zip:

Phone Number:

Email Address:

Jobs of Interest

Job(s) of Interest in Order of Preference:

Record of Employment

List most recent positions; a resume may also be submitted.

Employer 1:

Phone Number:

Address:

Position Title:

Supervisor:

Start Date:

Date Left:

Reason for Leaving:

Duties:

Employer 2:

Phone Number:

Address:

Position Title:

Supervisor:

Start Date:

Date Left:

Reason for Leaving:

Duties:

Employer 3:

Phone Number:

Address:

Position Title:

Supervisor:

Start Date:

Date Left:

Reason for Leaving:

Duties:

References

Reference 1:

Relationship:

Years Known:

Contact Information:

Reference 2:

Relationship:

Years Known:

Contact Information:

Reference 3:

Relationship:

Years Known:

Contact Information:

Reference 4:

Relationship:

Years Known:

Contact Information:

Statement and E-Signature

Please read this statement carefully before electronically signing this application.

I understand that employment at Bethany Theological Seminary (the School) is at-will, meaning that I or the School may terminate my employment at any time, or for any reason consistent with applicable state or federal law. I authorize the School to conduct a thorough background investigation of my work and personal history and verify all data given on this application and during interviews. I understand that my hire is contingent upon the results of the background check. I hereby release the School, and its representatives or agents, from any liability that might result from such an investigation. I authorize all individuals, schools, and firms named to provide any requested information and release them from all liability for providing the requested information. I understand this application will be active for the academic year listed above; after that time if I wish to be considered for a work study position, I must submit a new application.
I certify that all the statements in this completed application are true and understand that any falsification or willful omission shall be sufficient cause for dismissal from the job or refusal to hire. By entering my nine digit student ID number below I hereby electronically sign this application. If you do not yet have a student ID number please enter your date of birth.

E-Signature: *

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