Position:
Last First Middle
mm/dd/yyyy
Street City State Zip Code
Wichita State University Information:
Currently enrolled?
Check one:
Are you eligible for Work-Study?
Are you currently employed on campus?
Please fill in the box if you are currently employed on campus.
Employment History: (Please list your work history below beginning with your present or most recent job)
from to
May we contact?
from to
May we contact?
from to
May we contact?
References: (name, business, relationship, telephone)
To the best of my knowledge, all information on this application is true and correct. I authorize Wichita State University to use the information given in the determining my eligibility for employment, including contacting each of my former employers listed concerning my qualifications for employment. Permissions is also granted to each of my former employers to give Wichita State University information they may have with respect to my work experience with them. I understand that fraudulent statements made in this application may be cause for employment  at or dismissal from Wichita State University.
mm/dd/yyyy
Wichita state University does not discriminate in its employment practices, educational programs or activities on the basis of age, color, disability, gender expression, gender identity, genetic information, marital status, national origin, political affiliation, pregnancy, race, religion, sex, sexual orientation, or status of veteran. Retaliation against an individual filing or cooperating on a complaint process is also prohibited. Sexual misconduct, relationship violence, and stalking are forms of sex discrimination and are prohibited under Title IX of the Education Amendments Act of 1972. Complaints or concerns related to alleged discrimination may be directed to the Director of equal Opportunity or the Title IX Coordinator, Wichita State University, 1845 Fairmount, Wichita KS 67260-0138; telephone:(316)978-3187