1. MEP 2011-2012 Student Employment Application:

Please fill out the following application to be considered for employment with the Minority Engineering Program

* 1. Personal information:

* 2. What is your classification?

* 3. What is your major?

* 4. Are you currently enrolled at Purdue University?

* 5. In how many credit hours are you currently enrolled?

* 6. Are you eligible for work-study?

7. What is your work-study eligibility ($$amount)?

* 8. Are you currently employed on campus?

* 9. Position Applying For:

10. If you are applying for a tutor position, in which classes are you interested in tutoring? Check all that apply!

* 11. What interests you about the position(s) for which you are applying?

Please list your past employment history beginning with the most recent position.

12. Past employment/tutoring experience

13. Past employment/tutoring experience

14. Past employment/Tutoring experience

15. Employment Time Frame:

* 16. Availability

Please check the times in which you are available to work!

  Monday Tuesday Wednesday Thursday Friday
8:30 - 9:20 am
9:30 - 10:20 am
10:30 - 11:20 am
11:30 - 12:20 pm
12:30 - 1:20 pm
1:30 - 2:20 pm
2:30 - 3:20 pm
3:30 - 4:20 pm
4:30 - 5:20 pm
5:30 - 6:30 pm

* 17. Have you ever been charged with or convicted of a crime other than a traffic violation?

18. REFERENCES: Please list at least three people who can vouch for your skills, character, or background. (Do not use friends or relatives).Employers/Teachers make the best references. Please include their Name/Relation and a means to contact them.

19. In addition to english, what other languages do you speak?

* 20. I am applying for employment in the Minority Engineering Program. By signing my Electronic signature, I verify that the information given is true to the best of my knowledge. Enter your full name as your electronic signature.
E Signature:

* 21. Today's Date:

T