CALIFORNIA STATE UNIVERSITY, EAST BAY

UNIVERSITY POLICE DEPARTMENT

APPLICATION FOR STUDENT EMPLOYMENT
Please read through the entire Application and Personal History Statement, before answering. Respond to all questions as completely and accurately as possible. If you don't answer a question, please explain. All statements are subject to verification. Inaccurate statements may prevent or remove a candidate from employment. Additional pages may be attached as required. Please type or legibly print in ink (blue or black).

APPLICANT INFORMATION: POSITION: LAST NAME: PERMANENTADDRESS: PERMANENTPHONE~BER: MAILING ADDRESS: LOCALPHONENUMBER:.
EMAIL ADDRESS:

_ FIRSTNAME MI _ _ _ ~
_

PLACEOFBIRTH: NETID~ER: GRADE,MAJOR:

Are you a citizen of the United States?
If not, are you authorized to work in the United States?

_ ~ _ _
DYes
DYes

DNo
DNo

How did you hear about this position?

Briefly describe why you want this position.

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PERSONAL HISTORY STATEMENT

Briefly describe how you are qualified for this position by virtue of your interests, aptitudes, education and experience.

List any special skills, hobbies, abilities or training you have (such as clerical skills, foreign languages, computer experience, CPRIFirst Aid, Security, Lifeguard, etc.) that enhances your viability for this position.

What positive/negative experience or contact have you had with University Police Department Student Service Interns during your time at CSU East Bay? Did this contact influence your decision to apply?

How do you feel you can contribute to the Student Service Intern Program and what do you hope to gain from it?

The emergent and continuous nature of the University Police Department mission requires Student Service Interns to work varied shifts and hours. Describe how you would meet this obligation, while fulfilling commitments to school, clubs, sports and personal responsibilities.

List below all previous job experience, starting with your last employment. Include zip codes and complete phone numbers.

What do you feel you have gained from your previous work experience?

Have you ever been convicted of any crime or traffic violation (including but not limited to misdemeanors and infractions)? If yes, give details below.

Do you possess a valid Driver's License? Issuance. License #

0 Yes 0 No If yes, list license number and State of

State

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REFERENCES
Provide the following information for four non-relatives, non-employers who have known you for at least three years.

I hereby certify that all statements made in the above application are true.

Signahrre:

Dme:

DISCLOSURE CONSENT
Advisement To Applicants: You will undergo an in-depth background investigation as a result of your application for this position. This investigation will assist in determining your suitability for employment. Should the investigation uncover information that you have engaged in behavior or activities, which are illegal, or discredit your personal or professional background, the information may bar you from further consideration. Such information may be transmitted to the appropriate law enforcement agency for their independent investigation, or released to future employers upon presentation of a signed Disclosure Consent Form.

I certify that I have read this advisement, understand its contents and ramifications, have received a copy of the document, and knowingly consent to said disclosures to the California State University East Bay Police Department.

Position Applied for: Printed Name: Signature of Applicant: Witnessed By: ----' _ Title: -'--'--

_ _ _

Date:

California State University, East Bay

University Police Department 25800 Carlos Bee Boulevard Hayward, CA 94542-3053 Telephone: (510) 885-3791 FAX: (510) 885-3594