Employment Verification

Campus Attended

Bangor
Wilton

Student Name *

First

Last

Program Name: *

Graduation Date: *

Cell/Phone: *

Email: *

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

PLEASE CHECK ANY THAT APPLY

I am:

I am currently unavailable for employment because of:

Medical
Military

CURRENT EMPLOYMENT INFORMATION

Employer Name: *

Employer Address:

Address Line 1

Address Line 2

City

State

Zip Code

Position/Title: *

Hire Date: *

Start Date:

Supervisor Name: *

Supervisor Email: *

Job Duties:

Salary/Hourly Rate:

Company Phone #: *

Check one: *

Full-time
Part-time
Other

Specify Other:

Hours per week:

Benefits available: *

Yes
No

Authorized Representative Name:

Did the skills, tools, and knowledge provided by the University help lead to your hiring in your field OR help you maintain your current position? *

Yes
No

Obtaining a new position that:
Maintaining a position that utilizes the skill and knowledge learn in my program that:

Utilizes such skill and knowledge
Requires the credential provided through the program

Fulfills requirements for professional development
Fulfills requirements for a possible future promotion
Fulfills my goal of improving my job related skills

IF YOU ARE NOT EMPLOYED IN A JOB RELATED TO YOUR FIELD

Check the one item that best explains why you are not employed in your field *

I tried, but could not find a job in my field
I chose to enter a different job
I have not tried to find a job
Other

Explain

Would you like help finding a job in your field

Yes
No

IF YOU ARE SEEKING EMPLOYMENT

What position(s) are you interested in?

Full-Time
Part-Time

Would you like to set up an appointment with Career Services?

Yes
No

Which would be the best way to contact you?

Phone
Email

Do you want the Career Services Office to contact you about available job openings or career related workshops?

Yes
No

IF YOU ARE CURRENTLY CONTINUING YOUR EDUCATION

Name of School *

Start Date *

Program of Study *

Degree: *

Associate
Bachelor’s
Other

Specify Other

I can provide an acceptance letter, enrollment agreement, or other documentation to verify my enrollment in another college.

REASON FOR UNEMPLOYMENT

Medical

Medical Reason: *

Anticipated Availability Date: *

I can provide medical documentation

Military Service

Branch *

Stationed at (Base, City State): *

I can provide proof of military

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