Survey Research Institute: Jobs:

Cornell University Survey Research Institute

Online Application

Personal Information

*First Name:

*Last Name:

Current Cornell ID:

Non-school Email:

School Email:

Referral:

Permanent Contact Information

Permanent Address:

City:

State:

Zip:

Permanent Phone:

Local Contact Information

Local Address:

City:

State:

Zip:

Local Phone:

School Information

University and College:

Major:

Expected Graduation Date:

Work-Study Eligible:

Cornell Tradition Member:

Previous Employment Information

Please list the last two jobs that you have had:

Job 1:

Employment Date:

Wage:

Company/Organization:

Company Address:

Supervisor Name:

Supervisor Telephone:

Reason for Leaving:

Job 2:

Employment Date:

Wage:

Company/Organization:

Company Address:

Supervisor Name:

Supervisor Telephone:

Reason for Leaving:

References

Please list two references:

Reference 1

Name:

Address:

Telephone:

Email:

Relationship:

Reference 2

Name:

Address:

Telephone:

Email:

Relationship:

Work Experience

Please rate your knowledge of the following on a scale of 1 to 5, where 1 is little or no experience and 5 is mastery.

ITEM	RATING (1 TO 5)					NOTES/COMMENTS
MS Excel
MS Access
MS Word
MS Powerpoint
Adobe Photoshop
Lexis-Nexus
Eudora
Foreign Language (written)						Specify Language(s):
Foreign Language (oral)						Specify Language(s):
Statistics Software						Specify Software:
Telephone Experience
Customer Service
Other						Specify Other:

Please list any other relevant experience and special skills (computer software, language, etc):

Availability

*Date available to start:

*Weekly desired hours:

Please mark your overall shift availability below by checking ALL available shifts. (Below are the typical hours of operation, which may vary as needed.)

TIME	M	T	W	TH	F	SAT	SUN
9am - 10am
10am - 11am
11am - 12pm
12pm - 1pm
1pm - 2pm
2pm - 3pm
3pm - 4pm
4pm - 5pm
5pm - 6pm
6pm - 7pm
7pm - 8pm
8pm - 9pm
9pm - 10pm

Special availability notes: