Intramural Sports - Employment Application

Name Name First Last
EIU Email
Phone Phone - ### - ### ####
E#
Local Address Local Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Permanent Address Permanent Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Expected Graduation Date
Year in School

Year in School Freshman Sophomore Junior Senior Grad Student
Have you ever officiated for EIU Intramurals before?

Have you ever officiated for EIU Intramurals before? Yes No
If Yes, what year?
List other ON-CAMPUS Employment (where, when, supervisor) :
List other OFF-CAMPUS Employment (where, when, supervisor) :
Select Sport interested in officiating:

Select Sport interested in officiating: Flag Football Soccer Softball Basketball Indoor Soccer Wiffleball Volleyball Kickball Special Events
List all other sports you are interested in officiating:
Please list any officiating experience or qualifications you have:
How many hours would you like to work per week?:
What is your availability to work between 4:00 pm and 12:00 am each day (Sunday-Thursday)? Please list the times you cannot work due to class, extracurricular activities, etc.:
Sunday
Monday
Tuesday
Wednesday
Thursday
Spam Protection. Please answer this simple question.
In the number 29283, what is the 2nd digit?