Student Technician Application

Fill out this application form completely. Do not leave questions blank. If questions are not applicable to you, enter "NA." A separate application must be completed for each position applied for. The application must be signed and dated. Resumes will not be accepted in lieu of applications.

Angelo State University is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, physical or mental disability, Vietnam-era or special disabled veteran status.

Personal Information

Application Date
Name of position you are applying for
Last Name
First Name
Middle Name
Campus ID Number
Mailing Address:	Street/Box No.
	City
	State Zip
E-mail Address
Contact Phone Number
Classification
Approved for Work Study by Financial Aid Office	Yes No N/A
Are you at least 17 years of age?	Yes No
Have you ever been employed by the State of Texas?	Yes No
Are you currently employed by the State of Texas?	Yes No
If yes, list the agency/agencies
Have you ever been convicted of a felony or subjected to a deferred adjudication on a felony charge?	Yes No
If your answer is "Yes", explain in concise detail, giving the dates and nature of the offense, the name and location of the court, and the disposition of the case(s). A conviction may not disqualify you, but a false statement will.

Educational Information

Highest grade completed
Did you graduate from high school or receive a GED	Yes No

Previous Colleges Attended

College or University	Name & Location
	Sem. Hrs. Completed
Did you graduate?	Yes No
	Type of Diploma or Degree
	Major/Field of Study
Technical or Vocational	Name & Location
	Sem. Hrs. Completed
Did you graduate?	Yes No
	Type of Diploma or Degree
	Major/Field of Study

Availability

Date available for work
Desired number of work hours per week
Please indicate the hours you anticipate being available to work	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday
	Sunday

Employment Information

	Special Training/Skills/Qualifications: List all job related training or skills you possess and machines or office equipment you can use, such as calculators, printing or graphics equipment, computer equipment, and types of software and hardware.

Employment Record

Job 1:	Position Title Starting Date
	Employer Leaving Date
	Mailing Address
	City, State, Zip Starting Base Salary
	Employer's Phone No. Ending Base Salary
	Immediate Supervisor
	Supervisor Title
	Reason for leaving

Briefly describe your duties and responsibilities:
Job 2:	Position Title Starting Date
	Employer Leaving Date
	Mailing Address
	City, State, Zip Starting Base Salary
	Employer's Phone No. Ending Base Salary
	Immediate Supervisor
	Supervisor Title

	Reason for leaving

Briefly describe your duties and responsibilities
May we contact your previous employer?	Yes No
May we contact your current employer?	Yes No

List 3 professional or personal references

Reference 1:	Name
	Relationship
	Phone No.
	Address
Reference 2:	Name
	Relationship
	Phone No.
	Address
Reference 3:	Name
	Relationship
	Phone No.
	Address

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND INDICATE YOUR UNDERSTANDING AND ACCEPTANCE BY SELECTING THE CHECK BOX.

I certify that all the information provided by me in connection with my application, whether on this document or not, is true and complete, and I understand that any misstatement, falsification, or omission of information shall be grounds for refusal to hire or, if hired, termination.
I understand that as a condition of employment I will be required to provide legal proof of authorization to work in the U.S.
I understand that the State of Texas requires all males between 18 and 25 to register with the Selective Service and to present either proof of registration or exemption from registration upon hire.
I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my present and previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability from any damages which may result from furnishing such information to you.
I understand I have the right to request and be informed about information that the State of Texas collects about me. I am entitled to receive and review the information upon request. I also have the right to ask Angelo State University to correct any information that is determined to be incorrect. (Reference: Government Code, Sections 552.021 and 559.004)

Hardware/Software Experience

Evaluate yourself from 1 - 10, 10 being extremely proficient. Please answer as true to your ability as possible, interview will directly reflect your choices.

	Windows OS
	Apple Mac OS
	Linux/Unix OS
	Computer Hardware Components
	Printer Troubleshooting
	OS User Profiles
	Network Configuration
	Malicious Software/Virus Removal
	Active Directory Service
	Mobile Devices(iPhone, Droid, etc.)
Please discuss, in detail, your background and experience with technology:
Please explain, in detail, a time when you exhibited leadership skills:
Please explain, in detail, a time when you provided exceptional customer service:

Who Are You?

Student Technician Application

Angelo State University

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