Student Employment Application

Student Employee Application
Campus/Center:  Open Campus  Downtown Campus  Kent Campus/Cecil

 North Campus/Nassau  South Campus  Off-Campus
Personal Information Student ID #:___________

Last Name: First Name: Middle Initial: Today’s Date:
Address: City: State: Zip Code:
Email Address: Home Phone: Cell Phone:
Emergency Contact Person: Emergency Contact #: Relationship:
Are you a current FSCJ Employee? Have you worked for FSCJ before?  Yes  No
 Yes  No If yes, please list the department, campus and dates of
your employment:
Citizenship
Are you a citizen of the United States?  Yes  No

If no, do you have the legal right to work in the United States?  Yes  No
If no, what is your legal status in the country? Permanent Resident Non-Immigrant Visa Holder
Other Status: __________________
Note: You will be required to provide proof of citizenship or Department of Homeland Security
authorization to work in the US upon being offered a Student Work position at FSCJ.
Enrollment Date
What terms/sessions would you be available to work? (Check all that apply)
 Fall Term  Spring Term  Summer Term What is your program of study?
Session Session Session
 A  B  A  B  A  B
 C  D  C  D  C  D
Have you applied for financial aid?  Yes  No If yes when ______________________
Are you receiving financial aid?  Yes  No
Have you been denied financial?  Yes  No
Form OSE 001 Page 1
Work Preferences
Position Requested:
Check the time frame you are available to work:

 Morning  Afternoon  Evening  Other, please specify times:
8:00 – Noon 12:00 – 5:00 5:00 – 10:00
Work Experience
Please list all employers completely and accurately beginning with the most recent.
Name of Employer Telephone Name/Title of Supervisor
1
Address (Include City, State and Zip Code)
From To Full-time _______ Job Title

MO/YR MO/YR Part-time _______
Describe Duties/Responsibilities

2


3

Form OSE 001 Page 2

Background Information
Have you ever been found in violation of the Has there ever been a finding against you of any
Florida Code of Ethics or any other ethical employment-related harassment?  Yes  No
standard?  Yes  No If yes explain:
If yes explain:
I understand that Florida State College at Jacksonville (FSCJ) maintains a drug, alcohol, smoke and tobacco
free work environment and that laboratory screening for controlled substances, as defined by Florida Statutes
893.03 and/or Section 202, Schedules I and II, is required for applicants selected for any full-time employment
position, and any part time position in a safety sensitive area or selective admissions training program. If
selected for employment, I consent to pre-employment screening and agree to hold FSCJ harmless if
employment is denied as a result of positive results. If employed, I consent to such medical examination and
drug screening as may be required by FSCJ officials as a result of reasonable suspicion of my usage of
controlled substances and/or abuse of alcohol in contravention of the law or FSCJ District Board of Trustees
Rule.
I further understand that if I am a current or prior FSCJ employee, the supervising administrator, or designee,
in the department where the position is assigned has the authority to view my personnel file.
I agree not to engage in the unlawful manufacture, distribution, possession or use of controlled substance
while on FSCJ property or while conducting any activity involving the College.
I hereby certify that all statements made in this application are true and I agree and understand that any
misstatements of material facts herein may cause forfeiture on my part of all rights to any employment. I
authorize FSCJ to obtain reference/background checks as needed and agree to be fingerprinted. I understand
that my continued employment with FSCJ is pending successful processing of my fingerprints that will be
researched by state and federal law enforcement agencies.
I further understand that I may have access to individually identifiable confidential information, the
disclosure of which is prohibited by the Family Educational Rights and Privacy Act of 1974. I will not
in any way divulge, copy, release, sell, loan, review, alter or destroy that information including but not
limited to personal, academic and financial information about another student or employee.
Violations could subject me to criminal and civil penalties imposed by law. I further understand such
willful or unauthorized disclosure also violates the College’s policy and could constitute just cause for
disciplinary action including termination of my employment regardless of whether criminal or civil
penalties are imposed.
____________________________________________ _______________________
Applicant’s Signature Date
Form OSE 001 Page 3

Student Employment Application

Uploaded by

Copyright:

Available Formats

Student Employment Application

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Student Employment Application

Uploaded by

Copyright:

Available Formats

Student Employee Application

Campus/Center:  Open Campus  Downtown Campus  Kent Campus/Cecil

Personal Information Student ID #:___________

Address: City: State: Zip Code:

Email Address: Home Phone: Cell Phone:

Emergency Contact Person: Emergency Contact #: Relationship:

Are you a citizen of the United States?  Yes  No

Check the time frame you are available to work:

Address (Include City, State and Zip Code)

From To Full-time _______ Job Title

Name of Employer Telephone Name/Title of Supervisor

Address (Include City, State and Zip Code)

From To Full-time _______ Job Title

Name of Employer Telephone Name/Title of Supervisor

Address (Include City, State and Zip Code)

From To Full-time _______ Job Title

Form OSE 001 Page 2

Form OSE 001 Page 3

You might also like