Student Intern Application

Name: _______________________________________________Todays Date: __________________

USC ID#: ___________________________________Birth Date: _______________________________
Local Address: _______________________________________________________________________
Permanent Address: __________________________________________________________________
Email: _______________ Major______________ GPA: ______________ Workstudy: Yes / No
Year: (circle one) Fr

Soph

Jr

Sr

Other:_________________

Skills:_______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_
Hours available to work: (Fill in below)
Monday

Tuesday

Wednesday

Are you available to work in the Summer:

May
June

Thursday

Friday

Yes / No (fill-in days and times)

July
August

Previous Work Experience: (Please submit resume if available)

a)Employer: _______________________ Address: _________________________ Phone:
____________
Duties:_______________________________________________________________________________
From: __________________ To: _____________________
b)Employer: _______________________ Address: _________________________ Phone:
____________
Duties:_______________________________________________________________________________
From: __________________ To: ____________________
DEPT. USE ONLY
Required for payroll purposes id hired: Disability _____________
Ethnic ____________________

Veteran ________________

Country of Citizenship _______________________________

1sr day of pay ________________ Hourly Rate _______________ Auth. Signature._____________________