Work Study Interest Form

Educating Women

Who will change the world.

"Carry on steadfastly and faithfully the work you have undertaken."

St Angela Merici, Intro to the Counsels

Personal Information

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Graduation Year: *

Have you participated in the Work Study Program before? *

Yes

List previously held position and Supervisor.

Will you be seeking membership on any Beaumont's Athletic Team? *

Yes

If yes, please explain.

Availability

Shift preference: *

Before School

After School

Lunch Time

Any

Employment History

Employer 1

Company Name

Address

Phone

Start Date +

End Date +

Position

Salary

Supervisor/Manager

Reason for Leaving

May we contact? *

Yes

Phone Number

References

Reference 1

Name *

Title *

Email Address *

Relationship to Student *

Phone *

Reference 2

Name

Title

Email Address

Relationship to Student

Phone

Reference 3

Name

Title

Email Address

Relationship to Student

Phone

Additional Skills

List any additional skills that you would like to mention.