Application

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Application for Graduate Assistantship

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or differently-abling condition.

SECTION I: PERSONAL INFORMATION

LAST NAME*

FIRST NAME*

MI*

ADDRESS*

CITY*

STATE*

ZIP CODE*

HOME PHONE*

CELL PHONE

EMAIL ADDRESS*

Are you legally authorized to work in the United States?*
Proof of citizenship status will be required upon employment.

Yes

Have you ever been convicted of a crime other than a minor traffic offense? (A conviction will not necessarily automatically disqualify you for employment.)

Yes

If yes, please provide details (date and location for all convictions):

Have you ever submitted an application with Mount St. Mary's University before?*

Yes

If yes, please give dates:

Type(s) of assistantship preferred:*

Preferred Schedule*

Intended Degree*

Semester Hours completed in Current Program:*

Date of Availability:*

SECTION II: List all colleges and universities attended/attending, including MSM (most recent first)

INSTITUTION*

LOCATION*

MAJOR*

DEGREE SOUGHT*

DATES ATTENDED (FROM/TO)*

INSTITUTION

LOCATION

MAJOR

DEGREE SOUGHT

DATES ATTENDED (FROM/TO)

SUMMARIZE PERTINENT EXPERIENCE/SKILLS (TEACHING, RESEARCH, COMPUTER, LANGUAGE, etc.):

LIST LAST TWO EMPLOYERS (MOST RECENT FIRST)

EMPLOYER*

LOCATION*

POSITION*

DATES (FROM/TO)*

EMPLOYER

LOCATION

POSITION

DATES (FROM/TO)

Please upload your resume as indicated below.

Upload Resume

I hereby authorize my former employers and individuals listed herein to release to Mount St. Mary's University, and any agent acting on its behalf, my records from any and all former employers, references, and any or all educational institutions, as well as information as to my character and ablility and verification of matters stated herein. I hereby certify that the information supplied in this application and other submitted application materials are complete and correct. I understand that any omission or misstatement herein can be grounds either for refusing to hire me or for terminating my employment if I have already been hired. Moreover, I hereby release Mount St. Mary's, and any agent acting on its behalf, from any and all liability of whatever nature by reason of requesting such information from any person.

Signature

Date

http://auth.msmary.edu/bin/d/i/mARY 5W.jpg

I have read and agree to abide by the terms of this application.

Signature

Date

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