Student Employment Application
Louisiana Tech Department of Recreation
Position Applying For
Bowling Alley
Desk Attendant
Fitness Staff/Rocksteady Boxing
Intramural Official
Lifeguard
Rockwall
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Date of Birth
*
-
Month
-
Day
Year
Date
CWID
*
Major
*
Status
*
Undergraduate
Graduate
Hours Enrolled
*
GPA
Expected Graduation Date ( ex. Quarter/Year)
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employment History
Company
Position
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor's Name
First Name
Last Name
Supervisor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Company
Position
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor's Name
First Name
Last Name
Supervisor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Qualifications For Position
Emergency Contact Information
Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are there any health conditions that may prevent you from performing specific duties?
*
Yes
No
If yes, please explain the condition and any limitations:
Are there any special needs that you may require at this facility?
*
Yes
No
If yes, please explain the condition and any limitations:
Please list any Lambright Employee referral names.
Signature
*
Continue
Continue
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