University Resident Assistant Application Form

Are you CURRENTLY connected to a computer with printing capabilities?

Step 1: PERSONAL INFORMATION

Full Name

First NameMiddle NameLast Name

Phone Number

Format: (000) 000-0000.

Preferred Name/Nickname

Gender *

Other:

E-mail

Current Cumulative GPA (If you are a first year student or transfer student, please input "N/A")

Classification

Major *

Permenant/Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Number of semesters you have lived on campus, including this one *

RCL asks for a full commitment from RA staff members. Are you prepared to make a full year commitment should you be offered a position? *

How did you hear about this opening?

Step 2: LEADERSHIP HISTORY

Please list all of the extracurricular activities and/ or organizations that you are involved in, and the time commitment of each. Also, feel tree to list any extracurricular activities that you plan to pursue during the 2013-2014 academic year. *

Please list all of the leadership positions that you have held, currently hold and/or expecting to hold during the 2012-2013 academic year. *

Please provide a quote or personal motto that exemplifies who you are and an explanation of why this quote or motto is fitting to you. *

What are some particular aspects about the RA position that interests you? Also, what do you hope to gain from this experience? *

Describe some of your most rewarding experiences in the Residence Halls? Why are these experiences important to you?

Please indicate the residential communities in which you would be interested in working (Please note that your answer does not guarantee placement with the student population of your choice). Check all that apply. *

Please explain why you would be interested in the residential communities you indicated above. *

Step 3: REFERENCES & AUTHORIZATION

Please list 3 non-familial references. ONE REFERENCE MUST be from any current Longwood University Resident Assistant and faculty/staff member. The third reference is optional, but this can be used to include references from other professional experiences.

1.

Current RA Reference

First NameLast Name

Phone Number

Format: (000) 000-0000.

E-mail

How do you know this person?

2.

Reference #2

First NameLast Name

Phone Number

Format: (000) 000-0000.

E-mail

How do you know this person?

3.

Reference #3

First NameLast Name

Phone Number

Format: (000) 000-0000.

E-mail

How do you know this person?

Do you have a resume you would like to upload?

Upload your resume

By clicking the submit button, I authorize Residential and Commuter Life to verify my grade point average and my disciplinary record. I understand that I must be in good standing with the University and maintain a minimum 2.5 GPA.I also certify on my honor that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release Longwood University from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employement for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This online application does not permit the release or use of disability-related or medical information in a manner prohibited by the American with Disabilities Act (ADA) and other relevant federal and state laws.

I have read and agree to the above statement

Step 4: SIGNATURE, PRINT, & SUBMIT

Electronic Signature

First NameLast Name

Application Completed

MonthDayYear

Hour MinutesAM/PM Option

Signature