Application Period:

May 1 to August 30, 2019

Student #:

Last Name:

First Name:

Middle:

Home Address:

City:

State:

Zip:

Home Phone Number:

Cell Phone Number:

E-mail Address:

Major:

Expected Date of Graduation:

Students who are considered for Federal Work-Study employment will be referred to Campus Police to obtain fingerprints for a criminal history clearance through the State Department of Justice.

List any computer skills, training, and qualifications you possess:

Are you interested in working with children?

Yes   No 

If yes, what experience do you have with children? (Additional clearance will be required)

Have you previously been employed in the Federal Work-Study program at Cerritos College?

Yes   No 

If yes, where did you work?

Name of supervisor:

Are you currently employed?

Yes   No 

If yes, where?

Employment History:

Employer Name:

Title/Duties:

Dates Employed:

Reason for Leaving:

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Employer Name:

Title/Duties:

Dates Employed:

Reason for Leaving:

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Employer Name:

Title/Duties:

Dates Employed:

Reason for Leaving:

By typing my name, I certify that the information I have provided in this form is true and complete to the best of my knowledge.

Signature:

Date:

 

Once you have submitted your Federal Work-Study application, please refer to the 2019-2020 Federal Work-Study Hiring Process and Important Dates flow chart for more information on the hiring process timeline.

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