HTML Preview Work Service Job Application page number 1.
ASMSA Work Service Job Application
Students: Return the COMPLETED form to your Residential Mentor. (The due date to turn in your work service
applications will be announced by email and at floor meetings each nine weeks.)
CAUTION: Please do not leave this form with your supervisor assuming they will sign it. Stay with your supervisor
until the form is signed and then return it to your Residential Mentor by the due date at your floor meeting!!! Any forms
turned in incomplete or without valid signatures will be tossed out. Students who are not timely in turning in their job
applications may be subject to disciplinary action.
Student Name (Last, First):_______________________________________________
I am applying for the following job:
Job Title :______________________________________( cafeteria worker, maintenance asst., teacher aide, student
library aide, etc.)
Classification: Junior □ Senior □
Location of Work Service: _____________________________Supervisor: _____________________
My RM is: _____________________________________My room number is: ______________
Student Signature: __________________________________________Date: ______________
The section below must be completed by the supervisor!
I accept this student for work service in the position indicated above.
I understand and agree to fulfill all responsibilities as this students’ supervisor in the ASMSA work service program
and I will report my student’s work service performance to the Residential Life Coordinator, Laura Durr.
Signature: _________________________________Date: _____________Office Phone: ___________
The student and I have agreed that he/she will work the following days and hours:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Revised: August 2015