COLLEGE INTERVIEW FORM (Do not include information where prohibited by nrk14057


									                                                                                   COLLEGE INTERVIEW FORM
                                                                        (Do not include information where prohibited by law.)
Greenville, Pennsylvania

                          Name                           Last                        First                       Middle Initial   E-mail
 Personal Data

                          Present Address (Street, City, State, Zip)                                                      Present Phone, Area Code Check One:
                                                                                                                                                    U.S. Citizen ❑
                          Permanent Address                                                                               Perm. Phone, Area Code Permanent Resident ❑
                                                                                                                                                    Student Visa ❑

                          Brief Statement of Job Interests and/or Description of Work Desired
Work Preference

                          Date Available for Employment                    Geographical Preference                        Geographical Objections

                                                                         Dates (Mo./Yr.) Degree         Graduation Date
                                                                                         Earned or                            Academic Major         Grade Point Average
                          Name and Location of Colleges Attended         From     To Expected           Month Year
                                                                                                                                                    In Major:
                                                                            /        /                                                              Overall:
College Information

                                                                                                                                                    In Major:
                                                                            /        /                                                              Overall:
                                                                                                                                                    In Major:
                                                                            /        /                                                              Overall:
                          Honors, Activities and Organizations

                          Employment and Business Experience (include Permanent, Cooperative, intern, Volunteer, Summer work and any prior U.S. military service.)
                                                                                                                                           Hours       Dates (Mo./Yr.)
 Employment Information

                          Work Experience                                         Description of Work                                       per
                          (Name and Address of Employer)                          (Descriptive Title)                                      Week       From         To

                                                                                                                                                         /           /

                                                                                                                                                         /           /

                                                                                                                                                         /           /

                                                                                                                                                         /           /

 Credential Information

                                    A. In accordance with the Family Educational Rights and Privacy Act of 1974, I ________ WAIVE
                                       ________ MAINTAIN my right to review my placement credentials.
                                    B. For the purposes of furthering the Career Center’s efforts to assist me in securing employment
                                       or graduate school acceptance, I hereby ________ AUTHORIZE the Career Center to disclose
                                       information in my placement credentials including directory information.

                                    Date ____________________                        Signature of Candidate ______________________________

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