Co-op/Job Information Form

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Co-op/Job Information Form

Organization / Firm: Contact Person: Title: Company Address: Telephone Number: Fax Number: E-mail:

Please Complete the Following Job Information

Job Title: Duties and Responsibilities during the Co-op: Specific Majors Sought: Additional Comments:

Requirements:

U.S. Citizenship: Yes No
Automobile: Yes No

Starting Date (mm/dd/yyyy): Concluding Date (mm/dd/yyyy): Application Deadline (mm/dd/yyyy): Position available which semester(s)? Number of Openings Available: Student Level(s)?

Salary:

Amount ($):
Pay Period

Hours:

Part-time (minimum 15 hours per week) Full-time (minimum 35 hours per week) Contact Date:

Non-Discrimination Statement

This employer does not discriminate based on age, sex, race, religion, national origin, marital status or handicap. (required)

Yes No

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Millersville University is an Affirmative Action/Equal Opportunity institution;
a member of the Pennsylvania State System of Higher Education

Millersville University
PO Box 1002
1 South George St.
Millersville, PA 17551

Phone Number (717) 872-3011

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