Date: * Year Year20182019202020212022 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Semester Applying: * - Select -FallSpringSummer Personal Information Name: * Current Address: * City: * State: * Zip Code: * Current Phone Number: * Email Address: * Major: * Status (Check one): * - Select -FreshmanSophomoreJuniorSeniorGraduate Student Employment Information Position(s) you are applying for: * Have you been awarded work study?: * Yes No If yes, how much? If unsure, please visit MyUNIverse to view your financial aid award notification, located under the finances tab. Times available to work (list all times desired, remember to indicate a.m. or p.m.)Departments may or may not have your ideal schedule available. Try to be as flexible as possible. Sunday: Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Hours/Week * Employment History Employer 1 Name: * Employer 1 Phone: * Duties Employer 1: * Employer 2 Name: * Employer 2 Phone: * Duties Employer 2: * Skills Skills: * List specific skills you have (i.e. computer skills, writing, painting, carpentry, cash register operation, artistic skills, cooking, clerical, custodial, etc.) References Reference 1 Name: * Reference 1 Relationship: * Reference 1 Phone Number: * Reference 2 Name: * Reference 2 Relationship: * Reference 2 Phone Number: * The University of Northern Iowa endorses the intent of all federal and state laws created to prohibit unlawful discrimination. The University of Northern Iowa does not unlawfully discriminate on the basis of race, color, religion, sex, national origin, age, height, weight, marital status, familial status, handicap/disability, sexual orientation, or veteran status in employment or the provision of services, and provides, upon request, reasonable accommodation necessary to afford individuals with disabilities an equal opportunity to participate in all programs and activities. Electronic Signature * The above information is accurate to the best of my knowledge. I understand that completion of this application does not guarantee employment.