Work Study Application Form

*You may apply for up to 3 positions-complete app for each position

Instructions Students must complete an application for each position of interest and submit it to the contact
person designated in the Work Study Position Directory. Students may be selected for an interview by the
departments work-study supervisor. Placement in a position requires the preliminary approval of the
department and final approval, placement and notification through the Human Resources Office.
** RETURN THIS FORM COMPLETED AND SIGNED BY THE WORK-STUDY SUPERVISOR TO
THE HUMAN RESOURCES OFFICE WITH YOUR TAX FORMS AND PERMIT CARD

STUDENT SECTION : Department Supervisor will contact

student directly after final approval for start date.

Name: _____________________________________School I.D. #: ____________________

Home Address:________________________________________________________________
City

Home Phone: (______) _______ - ________

State

Zip Code

School Phone: (______) _______ - ________

Academic Year
Address:_____________________________________________________________________
City

State

Zip Code

E-mail: __________________________________________________
Current Major:____________________________

Academic Year: FR

SO

JR

SR

Have you ever worked at Point Park University: Y or N

Have you ever been a Federal Work Study Employee at Point Park University? Y or N
POSITION DESIRED: _____________________________________
DEPARTMENT: __________________________________________
Work Experience / Qualifications (Briefly describe both)

Signature of Applicant: ____________________________________ Date:_______________

(The above information is accurate and truthful)

APPROVAL SECTION - MUST have BOTH signatures to be approved to work

Department Supervisor signature: _________________________________________Date__________________
Student is accepted.

Human Resources Approval: _____________________________________________Date__________________

Student is approved for the position

Point Park University does not discriminate on the basis of race, color, national origin, religion, sex, age, veteran status,
sexual orientation or non job related disability.
Copies:

White:
Human Resources

Yellow:
Supervisors Student Folder