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Graduate Assistantship Application

Please enter the following information:
Email Address:
LAST Name:
FIRST Name:
MIDDLE Name or Initial:
Student Number:
Street:
City:
State:
Zip:
Home Phone:
Work Phone:
Date of Birth:
Gender: M F

Anticipated Entrance to
College of Graduate Studies:
Degree Sought:
Major:

Undergraduate Degree:
Date received:
Major:
Minor:
Received from:

Previous Graduate Degree:
Date received:
Received from:

Previous Teaching/Work Experience
Please list the following items for each position:
Dates, Employer Name, Address and phone, Title, Duties

Research Skills
List course and/or experience:

Skills and Abilities
Computer operations experience
Amount of experience:
Computer model(s) used:
Software programs used:

Availability: (check all applicable)
Term: Fall Spring May Summer I Summer II
Days: Mon Tues Wed Thurs Fri Weekends
Hours: Mornings Afternoons Evenings Other

Jacksonville State University is hereby authorized to investigate any part of my personal, educational, employment and credit history. I understand that if employed, false statements on this application or on employment enrollment forms shall be considered sufficient cause for dismissal. I also understand that, if employed, I must furnish identification as required by the Immigration Reform Act of 1986 on the first day of my employment. This identification will consist of my Social Security Card and one of the following: A State issued Driver's License with picture, a State issued ID Card with picture, U.S. Passport, or other acceptable identification.

I understand that, if I withdraw from school or if the number of hours I am taking falls below the required minimum number for eligibility to hold an assistantship, I will be responsible for paying the full amount of tuition as well as any other fees which may have been paid by the University as compensation for this position (i.e., room and board).

Jacksonville State University is committed to equal opportunity in employment and education. The University does not discriminate in any program including admission of students and employment on the basis of race, color, national origin, sex, religion, age, or disability.

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