Program Assistant Employment Application

General Information

Fields marked with an asterisk (*) are required.

Date of Application: (mm/dd/yr)

Semesters that you wish to keep your application active (you must be enrolled):

Fall     Spring     Both Semesters  

Personal Information

Student ID:   *
First Name: *
Last Name: *
M.I.:

Contact Information

Street:   *
City: *
State: *
Zip: *

Email: *
Home Phone:   - *
Times to Call:  
Work Phone: -
Times to Call:

Educational Background

Yes No
Have you ever applied to Financial Aid for a Work Study Award?
Have you received Financial Aid for Work Study?
How many hours each week are you available?
School or College in which you are enrolled:
Major(s):
Minor(s):
Status:
Current GPA:  

School From To Degree

Subject Areas of Expertise

Please indicate your strong subject areas in which you could assist tutors or Supplemental Instruction leaders. List undergraduate courses and grades in these subjects. You should have at least a B+ in each listed course.

Course No. Title UWM grade Other grade

Work Experience
(List most recent first)

Most recent position:

Postion

From

To

Agency or Firm

Supervisor

Address

Duties
Next most recent position:

Postion

From

To

Agency or Firm

Supervisor

Address

Duties
Next most recent position:

Postion

From

To

Agency or Firm

Supervisor

Address

Duties


References

Give at least three (3) references, such as professors or past employers, related to the subject(s) to be tutored or your working ability. We recommend that you have two letters of reference sent to us: Panther Academic Support Services, PASS/Bolton 180, University of Wisconsin-Milwaukee, P.O. Box 413, Milwaukee, WI 53201. If possible, one letter should be from a professor in your preferred subject area.

Reference 1:

Name

Title

Address
-
Phone Number


Reference 2:

Name

Title

Address
-  
Phone Number


Reference 3:

Name

Title

Address
-
Phone Number


Additional Comments



I hereby certify that the above is true, that this department may contact any of the above listed references, and that a UWM transcript may be released to the Department.

Input your name here if you agree to the above statement: