*****INFORMATION SERVICES*****

Student Employment Application

Position applying for:    (circle one or both)

Lab Assistant                                   Lab Technician

Today’s Date: ___________________

Full Name: ______________________________ PNC E-mail Address: ______________

Purdue University Identification Number (PUID): _______________

Address (including City, State, Zip):

________________________________________________________________________________

Home Phone #: ______________         Cell Phone #: ______________

(Which Phone # is best to reach you at first – Home or Cell?

Have you completed a Federal Student Aid FAFSA application? (NOTE: The completion of the FAFSA application is not required for this position.  It just entitles the applicant for possible work-study funding.)

Why are you interested in becoming a lab assistant?

How long have you been using a computer?

In which machine environment are you comfortable?

IBM-compatible___ Macintosh___ Both___ Neither___ Don’t Know___

Other ___________________________

List the application software you have used (if any).

List computer-related classes you have taken (if any).

What is your major (example C&IT)?

Describe your work experience (if any). Tell us where and when you worked, and briefly describe what you did.

Why do you think you would be a good lab assistant?

How many hours a week are you interested in working? 

Since this position may require you to work weekends as well, are you available to work both Saturday and/or Sunday?

Are you available to work mornings and/or evenings?

Have you ever been convicted of a crime? (Circle One)      Yes      No

If yes, list date, charge, place, court and action taken:

Please return this application, along with your class schedule, to the main desk in T265. 

Your application WILL NOT be considered without a current semester class schedule.  Completing an application does not guarantee employment – you will be notified if you will be hired.

If the semester already started, most likely a position (if any) will not be available until the following semester.  If a position does become available, you will be contacted by PNC email and a copy of your class schedule will be required to be hired.

I understand that employment in certain jobs at Purdue University North Central is conditional upon a review of criminal conviction records, and I authorize the University to request and obtain, through the Indiana State Police, a Limited Criminal Conviction Report as necessary.

I understand that employment at Purdue University North Central in jobs that work with or around children is contingent upon compliance with Zachary’s Law and a review of the Indiana Sex Offender Registry.

I understand that any false statement by me in this application or failure to provide any material information requested will be cause of rejection of my application or dismissal from any subsequent employment.

I understand I must be currently enrolled as a student and must immediately disclose if I am no longer enrolled.  Upon disclosure of enrollment, termination will be necessary.  Any changes or updates to my class schedule must be submitted immediately to my supervisor.

I understand some positions require my involvement with confidential records and confidential information.  With this in mind, I will be required to maintain strict discretion and confidentiality under the Family Educational Rights and Privacy Act (FERPA) and the Gramm-Leach-Bliley Act (GLBA).  I understand that any violation of either policies will result in my immediate termination.

Signature:_____________________________________ Date: ____________