Student Application

Your application will be on file for a maximum of 30 days.

Contact Information

Full Name:

Home Phone Number:

Mobile Phone Number:

Email Address:

Personal Information

The starting pay rate for student staff at UHCLC is $7.25 an hour. Is this acceptable?
Yes No

Are you 18 years of age or older?
Yes No

What degree are you working toward?

What is your classification?

UH Peoplesoft ID #:

Are you in good academic standing with UH?
Yes No

Do you currently have deliquent balance with UH?
Yes No

Have you ever been convicted of a criminal offence (other than a traffic violation) including DWI/DUI or received deferred adjudication within the last seven years?
Yes No

If you responded YES to the question above, please explain your conviction in full detail:

Work Experience

Have you worked with children before?
Yes No

Describe your work experience with children?

List any other qualifications/work experience that you have:

List any Special Talents you may have and/or Campus Activities you are involved in:

Explain why you would like an opportunity to work at UHCLC?

References

You must provide a name and phone number of one work/school reference:

Reference Name:

Reference Phone Number:

Work Time Availability

Monday:
to

Tuesday:
to

Wednesday:
to

Thursday:
to

Friday:
to