Today's Date: / /

Have you been awarded work study funds by the University's Financial Aid Office? (Work study is a financial aid award given by the federal government.)
Yes    No

Last Name:
First Name:

Campus Address (if applicable)

PO Box No.

Room No.

Dormitory

Campus Phone No. 502-854-

Permanent Address

Street

City

State

Zip Code

Phone Number: - -

E-mail address:

Have you ever been employed or interviewed in the Library? Yes No
      If yes, which department(s) and when?

Semester enrolled: Fall Spring Summer   Year: 2007 2008 2009 2010

How long do you plan to be at the University of Louisville?

Can you work some nights? Yes No
Can you work weekends? Yes No
Can you type? Yes No      Number of words per minute:
Do you have a driver's license? Yes No
Do you have any library related experience? If so, explain:

Please list any additional special abilities or skills (computer, filing, organizational skills, public service experience, media equipment, foreign language, web page design, writing, other):

If you prefer to work in one of the following libraries/departments listed, please check below. If more than one, please rank them in order of preference.

Employment Record

Number of hours per week you'd like to work:

Preferred Daily Work Schedule

If you are interviewed, you will be asked to sign the printed copy of this form. After hitting the submit button, please print off the results for your records. For this type of employment, state law requires a state and national criminal history background check as a condition of employment.