CSB Security Job Application

Today's Date:

First Name:

Middle Name:

Last Name:

Date of Birth:

Address:

City:

State or Country:

Zip Code:

Home Phone:

School Address - Residence Hall & Room Number:

Phone:

P.O. Box:

Year in School:
First Year Sophmore Junior Senior

State/Country of Drivers License Issue:

Have you ever been convicted of a criminal offense or had an underage consumption violation?

	Yes
	No

If yes, please explain:

Are you currently eligible for a full work award?

	Yes
	No

If no, please explain:

Will you be attending classes on campus both semesters next year?

	Yes
	No

If no, please explain:

Student security officers are regularly required to work nights and weekends, would this be a problem for you?

	Yes
	No

If yes, please explain:

Are you interested/available to work during the summer?

	Yes
	No

Are you interested/available to work during breaks?

	Yes
	No

Do you hold a current certification in CPR?

	Yes
	No

Do you hold a current certification in Basic First Aid?

	Yes
	No

Previous CSB/SJU Student Employment

1) Job Title:

Department:

Supervisor:

Please give a brief description of duties and responsibilities:

2) Job Title:

Department:

Supervisor:

Please give a brief description of duties and responsibilities:

Previous Employment History

Please give a brief description of duties and responsibilities:

Educational and Personal Goals

Educational:

Personal:

Please tell us why you believe you would be an asset to the Department of Security:

Leave this blank, it's here to thwart SPAM bots.