The UVM Connection > Get Involved > Students

UVM Chatty Cats Application Form

PERSONAL INFORMATION
Name: (Last, First, Middle Initial)
Local Address:

City:
State:
Zip:
E-mail:
Home Phone:
Cell Phone:
Permanent Address:

City:
State:
Zip:
If you use a nickname, please enter it here:
Would we need additional information in order to check your employment record? If yes, please explain:

WORK HISTORY (Please begin with your most recent work experience)
Date To/From:
Company Name:
Job Duties:
Your Title/Salary:
Reason for Leaving:

Date To/From:
Company Name:
Job Duties:
Your Title/Salary:
Reason for Leaving:
May we contact all of these employers for a reference?	Yes No
If no, which one(s) would you prefer we not contact?
EDUCATIONAL HISTORY
Major:
Year in school:
Expected graduation date:


Are you legally eligible to work in the United States?	Yes No
Have you ever been convicted of a felony? If yes, please give details and dates.
Note: Answering YES does not constitute an automatic bar to employment. Factors such as date of offense, seriousness and nature of violation, rehabilitation and position applied for will be taken into account.

Important: More scheduling flexibility strengthens your candidacy for the position. Please check ALL shifts you are available to potentially work to give yourself and Chatty Cats the opportunity to find the best suited 3 shifts to schedule you. Weekend availability is required and more than four shifts of availability is highly desired.
Monday 5:45 to 9:00 pm	Yes No
Tuesday 5:45 to 9:00 pm	Yes No
Wednesday 5:45 to 9:00 pm	Yes No
Thursday 5:45 to 9:00 pm	Yes No
Sunday 1:45 to 5:15 pm	Yes No
Sunday 5:45 to 9:15 pm	Yes No
If you have additional comments about your availability, please enter them here:
If you were referred to this position by anyone, give their name here:
PLEASE READ THE FOLLOWING STATEMENT CAREFULLY BEFORE SUBMITTING YOUR APPLICATION:
By clicking "Submit Application": I hereby certify that all statements made on this application & all other documents I have submitted in support of my application are true & complete to the best of my knowledge & belief. I understand that knowingly making a false statement or omission on this application may be sufficient cause for rejection of my application or dismissal after employment. I herby authorize IDC to investigate the information contained herein & release all references, previous employers & schools from damages resulting from furnishing such information. I also understand that my employment relationship is at will & may be terminated by either party at any time.