The Co-op Store

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Student Application Form

Full Name Date:
School Address


Phone:
Cell: 		Home Address:


Phone:
Year:  
Major:
Email  		Are you available during:
Summer? Yes No  Breaks? Yes No
Saturday? Yes No
Nights ? (1st two weeks in semester) Yes No

Most Recent Employer: 
Address:
City State Zip Code
Phone:

Describe the type of work experience that you have 

What interests you in working at The Co-op Store?

References:
Are you eligible to work in the U.S.? Yes No
If you are under the age of 18, do you have an employment / age certificate? Yes No
Have you ever been convicted of a criminal offense (felony or misdemeanor)? Yes No
If yes, please describe:
 
(Conviction will not necessarily disqualify an applicant for employment)
Please type class schedule from 8:00 a.m. - 6:00 p.m.
(example: Monday 8:00 a.m. - 8:45 a.m. ENGL 311)

Thank you for considering to work at your student owned Co-op Store


(Please only hit submit once)


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