Federal Work Study Application

Federal Work Study Application
Personal Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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?
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?
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)
If yes, give authority (city, parish, state, etc.) offense, date, place, and sentence.
Education Information
Are you currently a Fletcher student?
High School Name:
Do you have any previous college credit?
If yes, where and when?
Employment Information
Previous Employment
Do you have legal right to work in the United States?
May inquiry be made of your previous employers?
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