Name: |
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Cell Phone: |
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Email Address: |
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Campus Address: |
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Campus Phone Number: |
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Home/Permanent Address: |
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City: |
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State: |
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Zip: |
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Permanent Phone: |
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Summer Address (if different from home
address:
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City:
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State:
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Zip:
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Summer Phone:
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Summer e-mail address: |
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Grade Classification (Fall 2008): |
Freshman
Sophomore
Junior
Senior |
Major(s): |
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Minor(s): |
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Fall 2007-08 GPA: |
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Cumulative GPA: |
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Total credits by the end of the current
semester: |
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Expected graduation date: |
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How many semesters have you
lived on campus at Dana?
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Which hall(s) did you live in? |
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Have you lived on campus at
another college/university? |
Yes
No |
If yes, how many semesters
and where? |
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Have you previously served
as a resident assistant at Dana?
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Yes
No
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If yes, how many semesters and
in which hall(s)? |
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Have you previously served
as a resident assistant at another college?
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Yes
No
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If yes, how many semesters
and where?
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Time commitments: |
How many credits do you plan
to take in Fall 2008? |
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How many credits do you plan
to take in Spring 2009? |
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List any and all outside
commitments or pre-professional experiences you would be
involved with during 2008-2009 and the number of hours per
week needed per commitment (i.e. internships, clinicals,
student organizations or clubs, music ensembles, theater
productions, athletic, intramurals, etc.). When listing organization
or club involvement, please list if you are an officer (the
position you will hold) or member only. |
Commitment: |
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Hours per week: |
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Commitment:
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Hours per week:
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Commitment:
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Hours per week:
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Commitment:
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Hours per week:
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Commitment:
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Hours per week:
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Commitment:
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Hours per week:
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Do you plan to student teach
next year? |
Yes
No |
If so, what semester/where? |
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Leadership Experiences |
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List past and current leadership
positions/experiences, a brief description and dates of participation. |
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References:
You will need three (3) written references: one from your Resident
Assistant, one from a student on your floor and one from a former
employer, staff/faculty member, advisor or coach. Residence Hall
Directors and the Director of Residence Life are part of the interview
process and can not be used as references. Reference forms are
included and must be returned prior to the due date of your application
packet, February 8, 2008. |
Reference #1: |
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Address: |
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City, State, Zip: |
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Telephone: |
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Relationship: |
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Reference #2: |
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Address: |
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City, State, Zip: |
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Telephone: |
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Relationship: |
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Reference #3: |
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Address: |
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City, State, Zip: |
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Telephone: |
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Relationship: |
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I understand that this application
will be given every consideration but is not a promise of
employment. I understand that if hired, my employment is
an at will employment situation. I understand that I have
the right to terminate my employment at any time and Dana
College has the same right.
I certify that all answers to
the questions in this application are true and I further
understand that any false statement
and/or omission in this application will be sufficient grounds
for rejection of the application or for termination of employment
without notice. I authorize Dana College to make any and
all necessary and appropriate investigations to verify the
information
contained herein, including criminal records and work experience
checks. References obtained are done so in confidence and
I understand that my rights to review any reference material
may be waived. I also understand, that prior to employment,
I must provide information related to identity and employability.
Failure to provide appropriate documentation for verification
of employment eligibility may result in immediate termination
of employment.
In clicking below, I hereby certify
that I have read the above information, that I understand
the above information
and that I agree to abide by the above information. |
