Form

Thank you for your interest in applying for the Residential Life Staff for 2013-2014. Please complete all required sections of the following form to the best of your ability.

Local Address*

Permanent Address

Anticipated Summer Address

Personal History
By completing this section, the applicant grants University Housing staff access to student disciplinary and criminal records from the point of application until the end date of employment.
Gender

Male Female
Birth Date
Month Day Year
Resume*
# of Semesters Attending College*
# of Semesters Living in CSUDH Housing*
# of Semesters Serving as Housing staff*
# of Semesters Serving as Non-Housing staff*
# of Residential Conduct Case Hearings*
# of Campus Conduct Case Hearings*
# of Criminal Arrests*
# of Criminal Charges*
# of Criminal Convictions*
Anticipated Commitments for the Summer 2013*
Anticipated Commitments for the Academic Year 2013-2014*
Additional Comments

Academic References
By completing this section, the applicant grants the listed Academic Advisor permission to release academic records to Housing Staff from the point of application until the end date of employment for the purpose of monitoring minimum required G.P.A., full-time academic course load and adequate progress toward degree.
Academic Advisor*
First Name Last Name
Work Phone Number*
- Area Code Phone Number
Work Email*
# of Anticipated Attempted Units in 2013-2014*
# of Units Completed by the end of 2013-2014*
Anticipated Full-Time Academic Course Load*

Yes No
Adequate Progress Towards Degree*

Yes No
Expected Graduation Semester*
Expected Graduation Year*
CSUDH GPA*
Cumulative GPA*
Additional Comments

Personal References
By completing this section, the applicant grants Housing Staff permission to contact the listed References from the point of application until the end date of employment.
Reference #1*
First Name Last Name
Phone Number #1*
- Area Code Phone Number
E-mail #1*
Reference #2*
First Name Last Name
Phone Number #2*
- Area Code Phone Number
E-mail #2*
References listed above should complete the Online Reference Form by the Application deadline (5pm Thursday, February 28, 2013) for the applicant to receive full consideration.
Enter your initials to acknowledge you understand the Online Reference Forms must be completed:*
Additional Comments

Essays
A Residential Life Staff position requires you to live where you work.
Describe your life philosophy and why you believe in it.*

0/250
A Residential Life Staff position requires a student to be a leader among peers.
Describe a time you served as a leader within a community and explain why you were successful.*

0/250
A Residential Life Staff position requires you to make contributions to a larger unit.
Describe the most significant contribution(s) you made to a team or work environment in the past.*

0/250
Resident Assistants serve a diverse resident population.
Describe the type of student population you are most suited to work with and explain why.*

0/250
Graduate Assistants supervise other student staff who are often similar in age.
Describe your supervision style and why it is successful.*

0/250

Rate the difficulty of the Application*

	1	2	3	4	5	6	7	8	9	10
Easy											Difficult

How did you find out about the Residential Life Application Process?*

Flyer Website Word of Mouth (Non-RA) Word of Mouth (RA) Other (List Method Below)
General Comments*

Confirmation
Falsifying information during the Recruitment and Hiring process can disqualify an applicant.
There will be a mandatory meeting for all applicants on

Sunday, March 3rd at 8pm in Building A at University Housing.
Enter your initials to acknowledge your application is true, accurate and your own work.*
Full Name
First Name Last Name
Full Name
First Name Last Name
Should be Empty: