UCC Student Job Placement Registration                          
(This form is for UCC Job Placement only and information is not shared.)

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First Name *
Last Name *
UCC Student I.D. Number *
Primary Contact Number *
Alternative Contact Number
City *
Email Address *
Preferred Method of Contact *
Required
Do You Have a High School Diploma or GED? *
Student Status *
Program of Study *
College Graduate? *
If Yes, What Degree Received?
Are You Currently Employed? *
If Yes, What's Your Availability?
Work Availability *
Required
Prefered Work Shift. *
Required
Do You Have Previous Work Experience? *
If Yes, What Kind of Work Experience and For How Long?
Do You Have a Resume? *
If yes, please paste your resume here
Are You at Least 18 Years of Age? *
Do You Have a Valid Driver's License? *
Do You Have Your Own Reliable Source of Transportation or Do You Use the Bus System? *
Do You Have a Legal Right to Work in the United States? *
Please list up to three current UCC Student Job Placement postings you may have interest in as referrals to apply for.
Company name and Job title - E.G. (Oregon Employment Department - Draftsman)  .
Comments:
Please use the space below for any additional comments or information you would like to share.
Due to the high volume of assistance please select a time for an appointment to meet with me that would be good for you.
An appointment time will last about 30 to 45 minutes per visit. My office hours for appointments will be Monday, Tuesday, and Wednesday from 10:30 am - 2:30 pm and Thursday from 1:30 pm - 4:30 pm. No Fridays.

Please click this link below to schedule yourself an appointment to meet with me. Thank you! https://calendly.com/ben-horvath/appointment?back=1&month=2019-04
Disclaimer  
I have read the above statement and certify everything on this application is true and accurate. *
Required
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