G #:

Local Address:

Local Phone Number:

E-Mail Address:

Cell Phone Number:

Permanent Address:

Class Year:

Major(s):

Minor(s):

Are you a transfer student?

Are you eligible for work-study?

List any campus activities and organizations you are involved with at George Mason University:

List any leadership roles you have held within these organizations:

Please indicate the shifts you are available to work:

Employees are required to work a minimum of five shifts during a two-week period, including one shift on Saturday or Sunday.

Job Title:

Employer:

Phone:

Type of Business:

Supervisor:

Job Responsibilities:

Salary Per Hour:

Dates of Employment:

Reason for Leaving:

Job Title:

Employer:

Phone:

Type of Business:

Supervisor:

Job Responsibilities:

Salary per Hour:

Dates of Employment:

Reason for Leaving:

How did you hear about us?

In the space provided, please explain why you think it is important to give back to George Mason University.