Office of Student Employment
Please complete the following questions with as much information as you have available. All information is confidential and will be used exclusively to compile total figures.
Please review our privacy statement relating to information we collect, choice/opt-out, and correction/updating of personal information before proceeding. Required questions are marked with an (*).


* Student ID (This is the "C Number" assigned to you by the University.)

* Company/Name of Business Where You Worked

Company City and State

Work Phone (if available)

* Hours Worked Per Week
Please enter hours worked in a number/decimal format (i.e, 15.50 for 15 1/2 hours a week)

* Pay Rate
Please enter your pay rate in a number/decimal format (i.e. 7.25 for $7 dollars and 25 cents). Do not include the dollar sign ($)

* Date You Started Working (Month/Day/Year)

* Date You Stopped Working (Month/Day/Year)

Thank you for taking the time to complete these questions.