U of M Dearborn and U of M Flint Student Temporary Employment Form | U of M Dearborn and U of M Flint Student Temporary Employment Form Part 1: TO BE COMPLETED BY APPLICANT Personal Information Have you been awarded Work-Study? Yes No Date Prepared: Last Name: First: Middle: Give legal name as it appears on your . Social Security card. The name, including all letters and spaces must be 50 characters or less. . Social Security Number: UMID (if known): E-Mail: Are you legally eligible to work in the Yes No Local Telephone: ( ) Current Address: If you need to make a change to your current address, please update it via Wolverine Access. Freshman Junior Bachelors Masters Doctorate Academic Level: Sophmore Senior U of M Student Currently U of M Student Currently U of M Student Not Status Enrolled Half-time or More Enrolled Less Than Half-time Currently Enrolled U of M Employment Are you presently employed Yes No If yes, check this box affirming other employing department(s) have been contacted: elsewhere at U of M? Do you have any relatives now Yes No If yes, please list: Name: Dept: employed at U of M? Name: Dept: Current and Previous Employment (including U of M) Name and Address of Employer Job Title Dates (Mo/Yr) Name From Address To Name From Address To Have you ever been convicted of a crime?* Yes No If yes, give details in the space provided below. IDENTIFY ALL MISDEMEANOR AND FELONY CONVICTIONS Are there any felony charges pending against you?* Yes No If yes, give details in the space provided below. * A yes response does not automatically disqualify a job applicant from further consideration. Each application is evaluated individually, based on a number of factors including the nature of the crime, how long ago the crime and/or release from incarceration occurred, whether a sufficient or satisfactory work record has been established since the crime and/or release from incarceration, and the criteria of the position for which application is being made. Please give dates, places, charges and disposition of all .
