Education and Work History Supplement

Indiana University is an Equal Opportunity/Affirmative Action Employer.

PRINTABLE FORM

* = required information.

*Name:

Last First Middle

EDUCATION

	Name:	City, State:	Highest Grade Completed:	Graduated:	Major/Degree and year attained:
High School or GED				yes no
University or College				yes no
University or College				yes no
University or College				yes no
University or College				yes no

WORK HISTORY: List your work history beginning with the most recent position.

From: To: Name of Firm:

Address: Supervisor:

Duties Involved:

Salary: Reason for Leaving:

From: To: Name of Firm:

Address: Supervisor:

Duties Involved:

Salary: Reason for Leaving:

From: To: Name of Firm:

Address: Supervisor:

Duties Involved:

Salary: Reason for Leaving:

From: To: Name of Firm:

Address: Supervisor:

Duties Involved:

Salary: Reason for Leaving:

From: To: Name of Firm:

Address: Supervisor:

Duties Involved:

Salary: Reason for Leaving:

SPECIAL SKILLS

Special skills/foreign languages/certifications/licenses:

Special equipment/computer hardware or software/industrial machinery/video or teleconferencing :

*Signature:___________________________________________________________ *Date:__________________________________

By signing you signify that all the information you have provided is true.

Please fill out all required and requested information.
Incomplete information may cause your application to be rejected.

PRINT and mail this form with the Employment Application to the department you're applying.