Employment Application
Elizabeth and Malcolm Chace Athletic Center
Date:________
_____Spring _____Spring Break _____Summer
It is optional, but preferred that you attach a current résumé to supplement this application.
Personal Data (Please type or print clearly and complete all sections in full.)
_____________________________________________
First Name
MI
Last Name
_____________________________________________
Local/Campus Address
_____________________________________________
City
State
Zip
_____________________________________________
Permanent/Home Address
_____________________________________________
City
State
Zip
________________________
E-Mail Address
_____________________________________________
Year in School
Major
Date of Graduation
________________________
Work Study Grant (Yes/No)
Have you previously worked for Bryant University as a student employee?
Yes_______ No_______
________________________
Phone (list all numbers)
________________________
Phone (list all numbers)
If so, which department?___________________ Dates of employment: from_______ to _________
Desired Position (Rank these positions in order of interest - 1 for highest priority, 2 for second highest and so on.
Some positions require certifications and/or related experience.)
_____ Front Desk (Wellness Center)
_____ Group Fitness Instructor
_____ Personal Trainer
_____ Student Manager (Wellness Center)
Certifications (Check all current certifications you have earned. You must provide a copy of each certification.)
CPR, AED, and First Aid Certifications:
� CPR for the Professional Rescuer
Group Fitness Instructor
� Adult CPR
Personal Training
� Standard First Aid
Certifications (please list):
� Other:_________________
________________________________
� Other: ________________
________________________________
________________________________
________________________________
Previous Work Experience (Please attach an additional sheet if necessary to include all relevant work experience.)
Position #1:
____________________________________________________________________________________
Company Name
Job Title
Dates of Employment
____________________________________________________________________________________
Contact Name and Phone Number
May we contact your supervisor for a reference?
____________________________________________________________________________________
Responsibilities
Reason for seeking other employment
Position #2:
____________________________________________________________________________________
Company Name
Job Title
Dates of Employment
____________________________________________________________________________________
Contact Name and Phone Number
May we contact your supervisor for a reference?
____________________________________________________________________________________
Responsibilities
Reason for seeking other employment
Please list any volunteer or leadership positions held:
____________________________________________________________________________________
____________________________________________________________________________________
What are your qualifications, strengths or special skills related to this application?
____________________________________________________________________________________
____________________________________________________________________________________
Why do you want to work in the Elizabeth and Malcolm Chace Athletic Center?
___________________________________________________________________________________
____________________________________________________________________________________
How did you hear about these Chace Wellness Center employment opportunities?
____________________________________________________________________________________
By signing this form, I attest that the information provided on this application is given to the best of my
knowledge. I understand that falsification of any information, for any reason, will result in immediate
dismissal from the Elizabeth and Malcolm Chace Wellness Center.
____________________________________________________________________________________
Signature
Date
Please return this application, copies of relevant certifications, and optional résumé to:
Fitness Center Director, Elizabeth and Malcolm Chace Wellness Center • Bryant University • Smithfield, RI 029171284
For more information, call (401) 232-6182 or visit: http://www.bryantbulldogs.com/information/Chace_Wellness
Weekly Availability for________________Semester
Please indicate availability by marking (“X”) the time slots that you are NOT available to work.
SHIFT
MON
TUES
WED
THURS
FRI
SAT
SUN
6:30------7:00am
7:00------8:00am
8:00------9:00am
9:00-—10:00am
10:00—11:00am
11:00—12:00pm
12:00----1:00pm
1:00—--2:00pm
2:00—--3:00pm
3:00—--4:00pm
4:00—--5:00pm
5:00—--6:00pm
6:00—7--:00pm
7:00—--8:00pm
8:00—--9:00pm
9:00—-10:00pm
10:00---11:00pm
Name:____________________________ Local Phone #’s: ______________________
Local Address: _________________________________________________________
E-Mail:_____________________________ Requested hrs/wk: _____ min._____ max.
Any special requests:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
___________________________________________________________________________