IUPUI - Department of Psychology

Testing Lab Proctor Application

Position Information
This is a work-study position only
The testing lab is in SL070

PERSONAL INFORMATION
	Items with a * must be filled out.
NAME:	* First, Initial, Last
SEX:
ADDRESS:	*
CITY:
STATE / PROVINCE:	* USA residents please use 2-letter abbreviation.
COUNTRY:	*
POSTAL CODE:	*
PHONE:
STUDENT ID NUMBER:	*
VALID EMAIL	* (an invalid email will void the application):

REFERENCE:
Please Identify one employment reference excluding relatives who can speak on your behalf.
FULL NAME, RELATIONSHIP, PHONE NUMBER:
* Ex: 401-783-4011. Include extension if applicable. Please use hyphens only, no "+" or "( )" characters.

EMERGENCY CONTACT:
Please identify someone that we may contact in case of an emergency.
FULL NAME, RELATIONSHIP, PHONE NUMBER:
* Ex: 401-783-4011. Include extension if applicable. Please use hyphens only, no "+" or "( )" characters.


EDUCATIONAL AND BACKGROUND INFORMATION

YEAR IN SCHOOL:	Freshman Sophomore	Junior Senior
MAJOR:

RELEVANT APPLICATION INFORMATION

SEMESTER IN WHICH YOU ARE APPLYING:	Fall Spring	Summer I Summer II


Will you be registered for B104?	Yes No *


Will you be registered for B105?	Yes No *


Will you be registered for B310?	Yes No *


Will you be registered for B311?	Yes No *


Will you be registered for B340?	Yes No *


Will you be registered for B370?	Yes No *


Will you be registered for B380?	Yes No *


Will you be registered for C105?	Yes No *


Will you be registered for FIS 206?	Yes No *


Will you be registered for FIS 305?	Yes No *


Will you be registered for M118?	Yes No *


Have you ever taken a test in the Testing Lab?	Yes No *


If yes, which course(s) required you to test in the Testing Lab?
*


Have you ever worked in the Testing Lab before?	Yes No *


If yes, when did you work at the Testing Lab and in what position?
*

Are you eligible for work-study?	Yes No * I don't know
Have you ever held a work-study position at Indiana University Purdue University Indianapolis?	Yes No *

If yes, describe the position and identify the department where you worked.
*

SCHEDULE INFORMATION
Note that if you are Schedule to open the lab you will be expected to arrive 15 minutes early in order to prepare the lab for testing. If you are scheduled to close the lab, you will be expected to stay 30 minutes to 1 hour past lab closing in order properly shut down the lab. Please keep this in mind when identifying your availability. If you are available for more than one shift on the same day, please indicate both. (ex) 9-12, 3:30-5 The lab hours are: M-R 9-9, Fri - Sat 9-5, and Sunday 12-5

Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:

By initialing the box you indicate that all information provided on this application is correct. Applications deficient of the proper initials will not be accepted.
SUBMITTING THE APPLICATION

This application will be kept on file for one semester.