Position Title:
Position Number:
Department:
Series Number:

First Name:
MI:
Last Name:
Campus Address:
Campus #:
Campus Email:
Home #:

Have you graduated high school or obtained a GED?     Yes No
Business/Technical School attended #1:
Major/Studies:
Graduated? Yes No
Degree:

Business/Technical School attended#2:
Major/Studies:
Graduated? Yes No
Degree:

College/University attended#1:
Major/Studies:
Graduated? Yes No
Degree:

College/University attended#2:
Major/Studies:
Graduated? Yes No
Degree:

Other:

Beginning with your current position at Wright State, list previous work experience within the past 10 years.

Current Position:
Series Number:
Department:
Supervisor:
Have you completed your probationary period in your current classification?    Yes    No
Date Employment began: (mm/yy)
Full-time     Part-time
May we contact your current supervisor?    Yes    No
Supervisor's Campus #:

Duties and Responsibilities:

Previous Position:
Series Number:
Department:
Supervisor:
Date Employment began:   & ended: (mm/yy)
Full-time     Part-time

Duties and Responsibilities:

Previous Position2:
Series Number2:
Department2:
Supervisor2:
Date Employment2 began:   & ended: (mm/yy)
Full-time     Part-time

Duties and Responsibilities:

Why are you interested in this position?

What special skills and knowledge do you have that will help you be successful in this position?

Please list 3 references: (name, title, company, telephone number, email address)