Please fill out this form as completely as possible. If you do not know the requested information you can leave the question blank and we will contact you. If you realize you have made a mistake or your information changes after you have submitted the form, contact Custodial Services directly at 2030. Do not submit the form more than once.
*Semester
*Academic Year
*First Name
*Last Name
Birthdate
*Student ID
Year In School
Campus Email
Box Number
Campus Phone Extension
Cell Phone
Home Phone
Campus Housing Yes No
If yes, please select location
Room Number
Sports and other extracurricular activities:
Physical requirements: must be able to lift and carry 35 lbs repetitively, bend, kneel, push, pull, and work with cleaning chemicals and sprays. Please list any physical restrictions or limitations that may affect your ability to do this job with or without accommodation
Work restrictions, allergies, injuries, etc.:
Have you worked on campus previously? Yes No
If you are a returning student please indicate your preferred supervisor and desired hours. We will try to accommodate your request but cannot guarantee your desired schedule will be met.
Supervisor
Requested Hours
Have you accepted Student Employment as a part of your financial aid package? Yes No
Amount of Award
I am intersested in working at (on) 6:00 AM Saturday
Please use the check boxes below to indicate your current class schedule. Be sure to check any other times you are unavailable.
*Monday
No Classes
7:40
8:25
8:40
9:40
11:40
12:40
1:40
2:40
3:40
4:40
6:30
*Tuesday
9:05
10:35
10:40
12:00
1:20
2:45
4:10
*Wednesday
*Thursday
*Friday