Pre-Employment Questionnaire --
Ancilla College: An Equal Opportunity Employer

Positions are currently filled, please check back at a later date.

Today's Date: (mm/dd/yy)
Last Four Digits of Social Security No.:
New Student
  
Returning Student
Salutation: Ms.   Mrs.    Mr.
Name:
Email:
Phone No:
Address:
City:  
State:
  
Zip:
 
Are you 18 years of age or older?
   Yes   No
Are you either a U.S. citizen or an alien authorized to work in the United States?
   Yes   No
Have you ever been convicted of a felony?
   Yes   No
(Failure to report can result in termination of campus employment)
Major Area of Study:
Class Level in Fall of
(year)
Freshman
 
Sophomore
Special Skills and Qualifications:
Hobbies and Activities (civic, athletic, etc.):
Community Service Organizations and Activities:

In case of emergency notify:

Name:
Phone No.:
Address:
City:  
State:
 
Zip: