Employment Status Update Form

First Name

Last Name

Student ID

Email

Phone

Address

City

State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other

Zip Code

Goodwin Major/Program (field of study) General Studies Professional Studies Achievement in Water Management Dental Hygiene Environmental Health Technician Environmental Studies Funeral Service Health Science Histologic Science Histology Medical Assisting Medical Billing and Coding MPH Occupational Therapy Assistant Paramedic Studies Phlebotomy and Laboratory Services Public Health Respiratory Care Vision Care Technology Water Distribution Operations Water Treatment Operations Accounting Basic CNC Production Business Administration Certified Production Technician CNC Machining CNC Machining, Metrology, and Manufacturing Technology Computer-Aided Design (CAD) Industrial Service Technician Management and Leadership Manufacturing and Logistics Manufacturing and Production Manufacturing Management Mechatronics Manufacturing Management Medical Office Management Nonprofit Management Organizational Leadership (MSOL) Property and Casualty Insurance Quality and Manufacturing Inspections Quality Management Systems Robotics and Automation Supply Chain and Logistics Management Welding Accelerated BSN LPN MSN MSN-FNP MSN-PMHNP Nursing RN-to-BSN Advanced School Safety and Security Certified Addiction Counselor Child Study Criminal Justice Early Childhood Education Homeland Security Human Services Instructional Design Public Safety and Security School Safety and Security Teacher Leadership (M.Ed.) Violence Intervention Other

Major/Program Completion Month (Actual or Anticipated) April August December

Major/Program Completion Year (Actual or Anticipated)

Are you currently employed?

If yes, you are currently employed

Full Time Part Time

If you are currently employed, how did you learn about this position?

If you learned about this position in a way that is not listed, please specify:

Start Date

End Date

Current Employer

Job Title

Employer City

Employer State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Supervisor's Title

I'm currently employed in

My field of study Related field of study Unrelated field

If unrelated field, what field?

Are you currently enrolled in school?

If yes, what school are you attending?

Additional Comments