Application for Employment

Indiana University Center For Survey Research
Eigenmann Hall 2 South
1900 E. 10th St
(812) 856-2174

* Required

Personal Information

*Name: 
IU Username (if applicable): 
Preferred E-Mail Address: 

*Mailing Address: 
Second Address line (if needed): 
City:    State:    Zip: 
*Home Telephone #:  ()   extension: 
Best Time to Call: 
Secondary Telephone #:  ()   extension: 
Best Time to Call: 

 
Education
College/Institute Attended
(from/to)		 Degree

 
Work History

Most Recent or Current
Employer: 
Address: 
From:  To: 
Position/Title: 
Supervisor: 
Phone:  ()   extension: 
Second most recent
Employer: 
Address: 
From:  To: 
Position/Title: 
Supervisor: 
Phone:  ()   extension: 
Additional Experience
Employer: 
Address: 
From:  To: 
Position/Title: 
Supervisor: 
Phone:  ()   extension: 

 
Work Availability

Please check () the boxes corresponding to the shifts you can work.
Shift times are listed below with each shift.

 
 *
Sun Mon Tue Wed Thu Fri Sat
Morning 
Shift time:
9am-1pm
Afternoon 
Shift time:
1-5pm
Evening 
Shift time:
5:30-8:30pm
Late Evening 
Shift time:
8:30-11:30pm
*How many hours do you want to work per week on average?

*Do you currently work for Indiana University?
Yes
No
If YES, how many hours a week do you work for I.U.?  

*Have you previously worked for, or applied for a position with, the Center for Survey Research?
Yes
No
If YES, when? 
 
 
Other Qualifications

*What is your approximate typing speed?    words per minute.

*Please rate your knowledge of the following computer programs:
Application Experience
Microsoft Word:
Microsoft Excel:
Microsoft Access:
SPSS:


Please explain how your experiences and personal characteristics would help your job performance.

Other comments you wish to add for consideration.

 
 
Other Questions

*How did you find out about this employment opportunity?

  Bloomington Herald Times
  Indiana Daily Student (IDS)
  CSR Website
  Friends or Family
  Other means


*Are you planning to be in Bloomington for the summer months (May-Sept)?

  Yes
  No


Terms

* To comply with Title 8, United States Code, Section 1324A, which requires employers to verify employment of individuals, you must provide identification that proves your eligibility for employment in the United States. US citizens can provide: 1) a valid US passport, or 2) a valid driver's license plus an original social security card. Non-citizens require a valid foreign passport with attached Employment Authorization or an Alien Registration Card with photograph. These documents must be provided for verification before applicants can begin training.

I have read the Center for Survey Research Production Staff Job Description and understand the terms of the position for which I am applying. By checking this box, I indicate that the above information is true to the best of my knowledge and I understand that any falsification of this information is grounds for the disqualification of my application.