Phonathon Ambassador Application

Complete and submit the form below to register for Honors and Scholarship day.

*indicates required field

*First name
Middle name
*Last name
*City, State, Zip
Campus Mailbox No.
*E-mail address
Home phone
Cell phone
Date of birth mm/dd/yyyy


Are you legally eligible for employment in the U.S.A.?
(If yes, verification will be required upon employment)
Were you previously employed with the Phonathon?
Are you Eligible for a work study position?
If your application is considered favorable, you will be required to work a min of 3 shifts weekly from 6-9 p.m.
Check all that apply.

Are there any experiences, skills, or qualifications which will be of special benefit in the job for which you are applying?
What involvements do you currently have, or would like to have on campus? (I.e. clubs, organizations, athletics, honor societies, community service, etc.)
What do you currently know about the Virginia Wesleyan University Annual Fund?

As a graduate would you be willing to give to the Annual Fund, Why?

List Present and Past Employment Beginning with Your Most Recent

Name and Address of Company From: To:
Mo/Yr. Mo/Yr.
Supervisor Weekly Starting Salary Weekly Ending Salary
Reason for Leaving Describe the Work You Did:


Name and Address of Company From: To:
Mo./Yr. Mo/Yr.
Supervisor Weekly Starting Salary Weekly Ending Salary
Reason for Leaving Describe the Work You Did:


If there is a particular employer(s) you do not wish us to contact, please indicate which one(s)

I hereby give permission to contact the employer(s) listed above concerning my prior work experience.

Personal References (Not former employers or relatives)

Name and Occupation Years Known Phone Number

The facts set forth in my application for employment are true and complete.  I understand that if employed, any false statement on this application may result in my dismissal.  I further understand that this application is not intended to be a contract of employment, nor does this application obligate the employer to employ me.  I understand and agree that my employment is at-will and can be terminated at any time.  No one other than an officer of the Company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in writing signed by an officer. 

To Applicant:  The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin.  Federal law also prohibits other types of discrimination such as age, citizenship, disability, veteran status, attainment of benefits, and participation in union activities.  The laws of most states and many localities also prohibit some or all of the above types of discrimination as well as some additional types including, but limited to, discrimination based upon ancestry, marital status, parental status, sexual orientation, or source of income The Fair Credit Reporting Act imposes restrictions with respect to credit data.