Federal Work Study Application

Federal Work Study Application
Personal Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Student ID Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Last 4 numbers of SSN*
Major*
Applying for a specific department?*

YesNo
If Yes, which department?*
In the past 5 years have you been removed from a position as a result of misconduct or resigned to avoid such removal?*

YesNo
If yes, give name of employer and reason(s) for separation. *
Within the past 5 years have you been convicted of any law violation? (Exclude minor traffic violations)*

YesNo
If yes, give authority (city, parish, state, etc.) offense, date, place, and sentence. *
Education Information
Are you currently a Fletcher student?*

YesNo
High School Name:*
Do you have any previous college credit?*

YesNo
If yes, where and when?*
Employment Information
Previous Employment
Do you have legal right to work in the United States?

YesNo
May inquiry be made of your previous employers?

YesNo
I certify that the answers I have given to all questions in this application are true to the best of my knowledge. If I am appointed, I agree to promptly notify the proper agency official of any change in my status as a student, including any reduction in courses taken, termination of student status, or scholastic probation.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Personal Information