Lab Staff Application


Where would you prefer to work?	Portland Gorham Both
When would you like to start?
Personal Information
Full Name
Address
Home Phone
Email
Date of Birth
Emergency Contact Name
Emergency Contact Phone
Work & School Information
Do you have Work-Study?	Yes No
If yes, indicate amount
Do you have a car?	Yes No
Current year in school
Major
Provide class schedule; include campus on which class is located	Sunday: Monday: Tuesday: Wednesday: Thursday: Friday: Saturday:
When are you available to work?	Sunday: Monday: Tuesday: Wednesday: Thursday: Friday: Saturday:
When are you not available to work?	Sunday: Monday: Tuesday: Wednesday: Thursday: Friday: Saturday:

University of Southern Maine