AHS Application

APPLICATION FOR STUDENT EMPLOYMENT

Scope of the job:

Aggie Host Security Officers are non-sworn, student security personnel who support the mission of the UC Davis Police Department by providing a variety of public safety services to the campus, including the following: Special event security, safe rides services, and site surveillance.

Aggie Host Security Officers serve as members of the community providing an extra layer of protection and work directly with police officers assigned to the campus. Aggie Host Security Officers are equipped with portable radios that provide a direct link to the UC Davis 911 Emergency Dispatch Center.

UC Davis students in good standing are welcomed to apply. Employment is conditional upon a background check and the completion of specialized introductory and ongoing training.

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Position applied for:

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A). Personal Information:

Name

Student ID

Local Address

Permanent Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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First quarter enrolled at UCD:

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Expected graduation date:

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In case of emergency contact:

Name

Address

Email Address

Phone Number

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B). Have you ever been convicted of an offense by any court?

Yes

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You may omit:
1. Traffic violations for which the fine imposed were $50.00 or less
2. Any offense which was finally settled in a juvenile court or referred to the youth authority.
3. Any incident that has been sealed under welfare and Institutions code Section 781 or Penal Code Section 1203.45; and
4. Any conviction specified in Health and Safety Code Section 11361.5, which pertains to various marijuana offenses.

"A CONVICTION WILL NOT NECESSARILY DISQUALIFIED YOU FROM THE JOB WHICH YOU HAVE APPLIED"

If your answer is "yes" list the circumstances, places and dated in the space below:

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C). Do you have the legal right to accept work in the United States?

Yes

In compliance with the Immigration Reform and Control Act of 1986, individuals offered employment by the University will be required to show specified documentation as proof of authorization to work in the United States before hiring can occur. (Examples: U.S. passport; certificate of U.S. citizenship; temporary resident card; state-issued driver's license; U.S. Military I.D. card; original Social Security card; birth certificate issued by the Department of State.)

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D). List skills, special interests, or experience that might apply for this position:

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E). Do you possess a valid First Aid card?

Yes

If yes, type (Standard, Advanced, EMT, EMS) and expiration date.

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Do you possess a valid CPR card?

Yes

If yes, when does it expire:

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Do you possess a valid California Driver's License?

Yes

If yes, write the number, class (A,B,C,M) and expiration date.

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F). Work Experience: (List most recent employers first.) May we contact them?

Yes

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# 1- Employer Information:

Company

Supervisor

Position/Duties

Address

City/Town

Dates

Hourly Wage

Hours/Week

Email Address

Phone Number

Question Title

# 2- Employer Information:

Company

Supervisor

Position/Duties

Address

City/Town

Dates

Hourly Wage

Hours/Week

Email Address

Phone Number

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G). Are you currently or have you ever been employed by any other department on campus?

Yes

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University of California Work Experience

Department

Position

Dates

Hours per week

Email Address

Phone Number

H). References: (Other than relative, employers, or supervisors already listed)

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#1- References:

Name

Position or Title

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

#2- References:

Name

Position or Title

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

Please, upload your resume. The File size limit is 16MB.

Only PDF, DOC, DOCX, PNG, JPG, JPEG, GIF files are supported.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

EQUAL OPPORTUNITY EMPLOYER - AFFIRMATIVE ACTION

The University of California, in accordance with applicable federal and state law and university policy, prohibits discrimination against or harassment of any person employed by or seeking employment with the University on the basis of race, color, national origin, religion, sex, physical or mental disability, medical condition (cancer-related or genetic characteristics), ancestry, marital status, age, sexual orientation, citizenship, or status as a covered veteran (special disabled veteran, Vietnam-era veteran, or any other veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized). The University of California is an affirmative action/equal opportunity employer. The University undertakes affirmative action to assure equal employment opportunity for minorities and women, for persons with disabilities, and for special disabled veterans, Vietnam-era veterans, and any other veterans who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized. University policy is intended to be consistent with the provisions of applicable State and Federal laws. Inquiries regarding the University's equal employment opportunity policies may be directed to Provost and Executive Vice Chancellor and Affirmative Action Officer, Office of the Chancellor, 5th Floor Mrak Hall, (530) 752-2065 or FAX (530) 752-2400. Speech or hearing impaired persons may dial (530) 752-7320 (TDD).

CERTIFICATION: I certify that all of the statements made are true, complete and correct to the best of my knowledge and belief, and are made in good faith. I understand that the information I have provided on this application may be verified and that any falsification of information is grounds for disqualification or separation. I also understand that I will be required to sign an oath of allegiance prior to the appointment.

AHS Application

APPLICATION FOR STUDENT EMPLOYMENT

Question Title

Position applied for:

Question Title

A). Personal Information:

Question Title

First quarter enrolled at UCD:

Question Title

Expected graduation date:

Question Title

In case of emergency contact:

Question Title

B). Have you ever been convicted of an offense by any court?

Question Title

Question Title

C). Do you have the legal right to accept work in the United States?

Question Title

D). List skills, special interests, or experience that might apply for this position:

Question Title

E). Do you possess a valid First Aid card?

Question Title

Do you possess a valid CPR card?

Question Title

Do you possess a valid California Driver's License?

Question Title

F). Work Experience: (List most recent employers first.) May we contact them?

Question Title

# 1- Employer Information:

Question Title

# 2- Employer Information:

Question Title

G). Are you currently or have you ever been employed by any other department on campus?

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University of California Work Experience

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#1- References:

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#2- References:

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Please, upload your resume. The File size limit is 16MB.

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Signature of Applicant: