EmailMe Form - The W: Application for Employment

Name *
First Last
Cell Phone *
### - ### - ####
Campus Mailbox #
Wartburg students only.
Student ID #
Wartburg students only.
High School & Grad Year
School Address (if in high school)

Street Address City State / Province / Region Postal / Zip Code Country / Region
Home Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Year in School
Email *
Birth Date *
MM / DD / YYYY
Major(s)
Wartburg students only.
Minor(s)
Work Preferences & Experience
Check area of interest
Fitness Area Attendant
Climbing Wall
Child Care Attendant
Welcome Desk Attendant
Community Recreation Instructor
Please describe any experience you have for the areas above.
Previous Employment Experience

Employer Position Dates

Employer 1

Employer 2

Employer 3
List three personal or work references. *

Name Address Phone #

Reference 1

Reference 2

Reference 3
List any certificates that you hold that are applicable to the position applied for (i.e. WSI, Certified Nautilas Instructor, Group Fitness (Aerobics) Instructor).
List any additional information you may feel may qualify you for a position in Recreational Sports.