APPLICATION FOR WORK STUDY OR STUDENT

ASSISTANT POSITION
HUMAN RESOURCES | 408-924-2250

Instructions: Please print using blue or black ink pen. Submit to hiring department designee. Hiring department this is
for your internal use only. Do not turn in to HR.

GENERAL INFORMATION
Position Applying for: Department:
Student Assistant Student services
Last Name: First Name: Initials: Home/Message Phone:
Tadhani Miraj D 6692637691
Mailing Address: Year in school
101 E San Fernando Str, Apt 163 FR SO JR SR GRAD

City: State: Zip: Major: Expected Graduation Date:

San Jose CA 95112 Electrical Engineering May2018
1. Are you 18 years of age or older? If NO, a work permit is required at the time of employment. YES NO
Name:
2. Do you have relatives who work for SJSU? YES NO
Department:
If YES, provide information to the right.
Relationship:
3. Have you ever been employed at SJSU? YES NO Dates of Employment: Oct 2016- present
If YES, check status and provide information to the right. Student Assistant-Department:
4. Have you been convicted of a misdemeanor or felony as an adult (18 or older)? YES NO

If YES, please list circumstances and date. Exclude minor traffic and other convictions, which have been judicially dismissed,
expunged, sealed, or eradicated. Conviction of a crime is not an automatic bar to employment. All circumstances will be considered.
5. Are you currently eligible for the Federal Work-Study Program (if applicable)? YES NO

SKILLS AND ABILITIES

Typing Speed (WPM): 70 Application/Software Used

Word Processing MS word, Wordpad Some Exp Competent Expert

Spreadsheet MS Excel Some Exp Competent Expert

Database MS Access, My SQL Some Exp Competent Expert

Internet/Web Chrome, Mozilla, Safari, IE Some Exp Competent Expert

Programming Languages C, C++, Python, VB Some Exp Competent Expert

Computer Operating Systems Windows, Mac OS, Linux Some Exp Competent Expert

Other Some Exp Competent Expert

LICENSES AND CERTIFICATES: Complete this section only if license/certificate is required for the position.
Do you have a valid California Drivers License? YES NO Other Licenses and Certificate:
License No: Expiration Date:

AVAILABLE WORK HOURS

Monday 9 am- 3 pm Tuesday 12 pm - 5 pm Wednesday 9 am - 3 pm Thursday 12 pm - 5 pm Friday 9 am - 5 pm

Date Avaiblable to start work: 20th, Feb 2017 Hours available per week: 15-20 hoursKHS

HR Revised 1/30/2015 Page 1 of 2

 EMPLOYMENT HISTORY: List all employment within the last three years. Military or volunteer experrience may be
included
1. EMPLOYER: Job Title and Department Average Hours Per Week
KHS India Electrical design engineer 45
Employers Address Last Salary/Payment Basis Dates of Employment (Mo/Yr)
Gujarat, India 15000/annum 05/2013- 06/2016
Immediate Supervisory/Telephone No. Reason for Leaving:
9107966100030 Pursue higher study
May we contact? Yes No
Job Duties:
Machine programming, documenting the project manual
2. EMPLOYER: Job Title and Department Average Hours Per Week
KHS GmbH Embedded system Intern 40
Employers Address Last Salary/Payment Basis Dates of Employment (Mo/Yr)
Dortmund Germany 24/hour 12/2012- 05/2013
Immediate Supervisory/Telephone No. Reason for Leaving:
Schorn Wolfgang Joined the organization for full time
May we contact? Yes No
Job Duties:

3. EMPLOYER: Job Title and Department Average Hours Per Week

Employers Address Last Salary/Payment Basis Dates of Employment (Mo/Yr)

Immediate Supervisory/Telephone No. Reason for Leaving:

May we contact? Yes No

Job Duties:

REFERENCES: List at least three persons not related to you who can attest to your professional abilities.
Do not list family members or personal friends.
1. Name Occupation Telephone No.
Karan Shah Software engineer, greenninja 16692940916
2. Name Occupation Telephone No.
Gagan Goyal student assistant, child center 14089637637
3. Name Occupation Telephone No.
nitya kothari electrical engineer,KHS 919638995253

PLEASE READ CAREFULLY BEFORE SIGNING:

I hereby certify that all statements made on this application and all other documents I may have submitted in support of my application
are true and complete to the best of my knowledge. I understand that my stated pre-employment qualifications are subject to verification
and I hereby authorize the University to confirm any information provided. I understand that any falsification of my application materials
may be cause for disqualification from further consideration or termination, if such information is determined after employment. If
selected for employment, I agree to be fingerprinted, if required for the position. I understand that as a condition of employment, U.S.
citizens are required to sign the State of Californias Oath of Allegiance and non-U.S. citizens are required to sign the Declaration of
Permission to Work. SJSU only hires individuals lawfully authorized to work in the U.S. If hired, I agree to provide proof of my identity
and work authorization as required by the Immigration Reform and Control Act of 1986.

17th, Feb 2017

Signature Date

HR Revised 1/30/2015 Page 2 of 2