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An offering of Penn State


Urban Service Experience
Penn State Community Service Orientation Program 2008

Staff Application
Please type or print clearly.

Application due by March 10, 2008.
Items with an asterisk (*) are required.

Name*:  
Penn State ID no*.:  
Local address:
City:
State:    
ZIP code:
Phone*:
Cell phone*:

Home address:
City:
State:    
ZIP code:
Permanent phone:
 
E-mail*:
Alternate e-mail:
T-shirt size*:
What is the best way to contact you over the summer?  
Have you ever participated in community service? 
Yes No

If so, what did you do?
What leadership roles/positions have you held? 

Please indicate the dates when you would like to work.* (Ideally, we prefer to hire staff who will work both sessions. However, this is not mandatory and it will not keep you from being hired if you cannot attend both.)
Week 1 (July 27–August 1); Staff training takes place July 26 (mandatory).
Week 2 (August 3–8); Staff training takes place July 26 (mandatory).
Why do you want to be a leader for Urban Service Experience? 

Will you be 21 years of age before the first day of your program?*
(This is simply to determine whether or not you are able to drive a fleet van, and it has no bearing on your employment status.) 
Yes No

Will you be 25 years of age before the first day of your program?*
Yes No

If yes, would you be comfortable driving a 15–passenger van in the city?*
Yes No

What is your most advanced, current first aid certification? (Specify name of certification; include CPR.) 

Are you currently a Penn State student?*
Yes No 		How many semesters will you have completed by August 2008?*
Are you familiar with the city of Philadelphia?*
Yes No
Employment History
Please list your last three employers, assignments, or volunteer activities, starting with the most recent.
Employer 1
Employer*:
Phone number*:
Dates employed:
Job title:
Address:
   
City:
 
State:
ZIP code:
Immediate supervisor:
Supervisor's title:
Summarize the nature of the work you performed and your job responsibilities: 


Employer 2
Employer*:
Phone number*:
Dates employed:
Job title:
Address:
   
City:
 
State:
ZIP code:
Immediate supervisor:
Supervisor's title:

Summarize the nature of the work you performed and your job responsibilities: 

Employer 3
Employer*:
Phone number*:
Dates employed:
Job title:
Address:
   
City:
 
State:
ZIP code:
Immediate supervisor:
Supervisor's title:
Summarize the nature of the work you performed and your job responsibilities: 

Skills and Qualifications
Summarize any special training, skills, certifications, and/or characteristics you have that will help you to better perform your duties as an Urban Service Experience leader.



References—Please list three.

Reference One
Name*:
Title*:
Phone*:
E-mail:

Reference Two
Name*:
Title*:
Phone*:
E-mail:

Reference Three
Name*:
Title*:
Phone*:
E-mail:

Many of the photographs included throughout the site are © Sven Zellner. For a listing, please contact us.
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The Pennsylvania State University | This page was last modified on Friday, March 07, 2008