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

Applications will be accepted beginning July 17th 2010 for all openings

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:
*