APPLICATION DATE: ____________________
2013- 2014 APPLICATION FOR STUDENT EMPLOYMENT
PERSONAL INFORMATION
Name: _______________________ _______________________
Last First
Local Address: _________________________________ ___________________________ _____________________
Street City, State, Zip
*If you are living on campusplease list your dorm and house name _________________________________________
Permanent Address: _______________________________ ________________________________________
Street City, State, Zip
Preferred Email: ____________________________ CNetID: _______________ Student ID Number: ______________
Phone: _____________________ Year in school: ____________ Anticipated Graduation Date: ____________
Major: _______________________________ Date of Birth: ____________ Are You a U.S. Citizen?: Yes No
College Advisor: _______________________________ ___________________
Name Phone
Emergency Contact Information: ______________________ _________ ___________________ _________________
Name Relation Phone
_______________________________________________________________ ____________________________________________________________
Address Email
Potential Employment Status: Work Study Eligible Non-Work Study Volunteer
*If a paid position is not available, would you be willing to volunteer?: Yes No
QUESTIONAIRRE
How did you learn about NSP? ________________________________________________________________________
Do you have previous experience with NSP? Yes (If yes, please list the year/site ___________________) No
Were you ever a student or a graduate of a Chicago Public School? Yes No
If yes, what school(s)? _______________________________________________________________________________
Are you currently employed on campus? Yes If yes, where?: _______________________________ No
Do you have access to a vehicle (car or bike)?: Yes No __________________
Are you fluent in any languages other than English? Yes No
If yes, what languages? : __________________________________________________________________________
Revised: 7/13
INTERESTS
Please rate your level of interest on the following:
Content Area Very
Interested
Interested Neutral Not
Interested
Teaching
School Administration
Urban School Policy or Reform
Local Government Issues
Working off Campus
Meeting people from different
backgrounds
What level of knowledge/experience do you have with Chicago Public Schools?
None Very little Moderate Knowledge Much Knowledge
NSP Positions of interest (Check all that apply):
Elementary (1-5) Middle School (6-8) High School(9-12) CUIP (Technology)
Preschool (Jumpstart) Womens Shelter Community Center Administrative
EXPERIENCE
Describe your experiences working with children ages 3-18:
Describe your community service and extracurricular activities over the past 4 years:
Please list any CURRENT extra-curricular/service activities youre involved with and rank their importance:
Is there any specific activity you would like to do with the Neighborhood Schools Program?
YOU MUST BRING THE FOLLOWING WITH YOU TO YOUR INTERVIEW OR YOU WILL NOT BE INTERVIEWED:
1. PROPER IDENTIFICATION: A PASSPORT OR PICTURE ID AND SOCIAL SECURITY CARD.
2. IF YOU ARE WORK STUDY ELIGIBLE, YOU MUST BRING YOUR WORK STUDY FORM WITH YOU (AVAILABLE on CMORE)
*Please be advised that some organizations and schools may require satisfactory completion of a criminal history check and/or health screening before
allowing participation in a paid or volunteer service opportunity. If you have questions or concerns, we encourage you to speak to a professional staff
member at NSP*. If you have any questions, or if you are an international student, please call the NSP office at (773) 834-1935.
Days/ Times Available to work: (NSP Operates 8a-6p AND 10-2p Saturday for select programs):
MON: ___________ TUES:___________ WED: ___________ TH: ___________ __ FRI: ____________ SAT: ______________