Lafene Health Center
Kansas State University
1105 Sunset Avenue
Manhattan, KS 66502-3761
785-532-6544
lafene@k-state.edu

Student Employment Application

This is only considered an application for student employment. Applicants desiring full-time or part-time employment with the State of Kansas should contact the Department of Human Resources, 103 Edwards Hall, Kansas State University.

Print, complete and return to:

Lafene Health Center
1105 Sunset Avenue
Kansas State University,
Manhattan, KS 66502-3575

Name: ___________________________________________________(first, middle, last)

Email address: __________________________ Today's date: ____________________

Present address: _________________________________________________________

Telephone number: _______________________________________________________

Permanent (hometown) address: ____________________________________________

Telephone number: _______________________________________________________

Lafene is committed to a policy of nondiscrimination on the basis of race, sex, national origin, handicap or other non-merit reasons, in admissions, educational programs or activities and employment, required by applicable laws and regulations.

Position desired: _________________________________________________________

Currently employed with another KSU department? (yes or no)

Work study? (yes or no)

If yes, how much? ________________________________________________________

How long will you be in Manhattan? ___________________________________________

Availability date: ___________________ Number of hours available: ________________

Are you available during school breaks? (yes or no)

Are you available during the summer? (yes or no)

How many hours are you available to work during the summer? ____________________

List special training or knowledge or skills, i.e. typing, computer, etc.:

______________________________________________________________________

Education

Name & location of schools or colleges:	Major	College degree	Period of attendance
			From:	To:

Employment history

Name, address, telephone number	Duties	From	To	Reason for leaving

Work references (not relatives)

Name	Address	Telephone	Relationship

Spring, summer or fall class schedule (circle correct semester)

List all times you are AVAILABLE to WORK between the hours of 8 a.m.—7 p.m., Monday through Friday and 10 a.m.—2 p.m. on Saturdays.

Time available	Mon	Tue	Wed	Thur	Fri	Sat
(example: 8:05 a.m.—9:20 a.m.)	X		X

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