Our goal is to provide students, faculty, staff and visitors a safe environment to live, study and work. You are a partner in this mission.

Student Employment Application

General Information

All applicants must have an I-9 (Employment Eligibility Verification) form on file with the Financial Aid Office (Todd Wehr Hall, room 136) before they can begin working. This can be taken care of after a job offer has been officially extended to the applicant.

The hours that may be worked for each position are noted, however individual shifts within these times may vary according to scheduling needs.

Personal Information
First name: 
Last name: 
Student ID #: 
Suite #: 
Local address: 
Room / Apt. #: 
Local phone: 
Cell phone: 
Permanent address: 
City: 
State: 
Zip: 
Birth date:      19 
Email address: 
Miscellaneous Information
Why do you desire employment in the Campus Safety department?
Have you ever been employed by St. Norbert College? 
 Yes  No
If yes, list position(s), date(s) and supervisor name(s):
How did you hear about this position?

Are you able to enforce policies amongst your peers? Explain:

Driver's license #: 
Driver’s license state: 
Driver’s license exp. date: 

Have you ever received any motor vehicle citations?
 Yes  No

If yes, give dates and types of all citations received:

Have you ever been convicted of a crime other than a minor traffic violation?
 Yes*  No

If yes, give dates, offenses, charges:

*A conviction will not necessarily bar you from employment. Convictions are considered with respect to time,
circumstance, seriousness and relationship to job for which you apply.

Education & Training Information

Year in school:
 Freshman
 Sophomore 
 Junior 
 Senior

Major(s):  
Minor(s): 

How many credits are you taking this semester? 
Cumulative GPA: 

Expected graduation date:  

Are you now, or have you been, trained in these areas:

Emergency medical response
 Yes  No

Firefighter
 Yes  No

Law enforcement/security
 Yes  No

Other relevant specialized education and/or training:
Schedule
Student Assistants are required to be available to work two weekends per month.
How many hours would you prefer to work per week? 
Please note any a.m. or p.m. hours that you are unable to work due to school or other obligations.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Employment Experience
Are you currently employed?
 Yes  No
May we contact your present employer?
 Yes  No
Present or most recent employer
Company:
Address:
City, state, zip code:
Job title:
Job duties:
Reason for leaving:
Immediate supervisor name and phone:
Dates of employment:  to 
Hours per week: 

Starting salary:  /hour
Ending salary:  /hour

Previous Employer:
Company:
Address:
City, state, zip code:
Job title:
Job duties:
Reason for leaving:
Immediate supervisor name and phone:
Dates of employment: to
Hours per week:
Starting salary: /hour
Ending salary: /hour
Previous Employer:
Company:
Address:
City, state, zip code:
Job title:
Job duties:
Reason for leaving:
Immediate supervisor name and phone:
Dates of employment: to
Hours per week:
Starting salary: /hour
Ending salary: /hour
Character References 
(Please do not list family members)
Name 1: 
Occupation: 
Address: 
Phone number: 
Name 2: 
Occupation:
Address: 
Phone number:
Name 3: 
Occupation: 
Address: 
Phone number: 
Comments
Additional comments which you feel would be important in our consideration of your application:
Interview Contact
If selected for an interview, I can best be contacted between the hours of
   and  
Applicant Certification

I certify that the statements made in this application are true and complete, and I understand that my employment may be terminated at any time for any statement, misrepresentation or omission of fact on this application. The completion of this application and acceptance by the St. Norbert College Campus Safety department does not guarantee employment. I also understand that background checks may be conducted as part of the selection process.

I voluntarily and knowingly authorize any former employer, school or government agency to release any and all information concerning my former employment to St. Norbert College. I understand that this employment information may include, but is not limited to, performance evaluations and reports, job descriptions, disciplinary reports and options regarding my suitability for employment possessed by it.

By typing my name below, I acknowledge that I have read this section and understand it.

Name