SRL Chicago Office Interviewer Application Form

FIELD INTERVIEWER AND SUPERVISOR APPLICATION FORM

We welcome submission of resumes and cover letters in addition to the mandatory on-line application. If you would like to send a resume or cover letter in support of this application, please e-mail it to jobs@srl.uic.edu. In your email please let us know that you have also applied on-line. Thank you!

( * Required Field )

Please select the office location
that you are applying for: *

Please select the job position
that you are applying for: *

First Name: *

Last Name :*

Local Street Address: *

City: *

State: *

Zip code: *

* At least one phone number is required
(exp. 312-222-2222)

Home Phone Number:

Work Phone Number:

Cell Phone Number:

Email Address: *

Please record your education experience below. Begin with your last high

school, and list schools or colleges attended after that.

* At least one high school and/or college information is required

School or College: *

City, State: *

Years Attended (yyyy - yyyy): *

Major: *

Degree/Diploma: *

School or College:

City, State:

Years Attended (yyyy - yyyy):

Major:

Degree/Diploma:

School or College:

City, State:

Years Attended (yyyy - yyyy):

Major:

Degree/Diploma:

1a. Are you currently employed? *

1b. How many hours per week are you
currently working? * (if 1a is "Yes")

2. Have you ever been employed? *

3. Please list all relevant employment information, beginning with your current or most recent
job. * (if 2 is "Yes")

Employer:

Dates of employment (mm/yyyy - mm/yyyy):

Job Title:

Employer:

Dates of employment (mm/yyyy - mm/yyyy):

Job Title:

4a. Are you currently enrolled in an
undergraduate or graduate program? *

4b. At what school? * (if 4a is "Yes")

4c. How many credit hours are you
currently taking? * (if 4a is "Yes")

4d. When do you plan to graduate/get your
degree? * (if 4a is "Yes") (mm/yyyy)

5a. Do you have any survey research interviewing experience? *

5b. Have you had experience with ...
* (if 5a is "Yes")

1) Telephone interviewing?

2) Face to face interviewing?

3) Other type of interview?(PLEASE SPECIFY TYPES)

5c. Please describe these survey interviewing experiences if not already listed under
employment. (INCLUDE EMPLOYER AND DATES)

6. Please list any other experiences (workshops, conferences, work, hobbies,
etc.) you may have had that might be relevant to interviewing or survey research.

7. Are you usually available for... *

Daytime interviewing?

Evening interviewing?

Weekend interviewing?

8a. Please specify any time(s) of the day or week when you are not available: *

8b. Please specify any time(s) of the year that you are not available:: *

9. What is the maximum number of hours per week that you could devote to interviewing? *

10a. Do you speak any foreign language(s) fluently? *

10b. Which language(s)? * (if 10a is "Yes")

11a. Do you type? *

11b. How many words per minute?
* (if 11a is "Yes")

12a. Do you currently have a valid driver's
license? *

12b. Do you have unrestricted use of an automobile in good running condition? *

12c. Do you currently own a car? *

13a. Have you ever been convicted of a crime? *

13b. If yes, please explain: * (if 13a is "Yes")

14. List two references, including former employers if possible, who can advise us of your

qualifications. (DO NOT LIST RELATIVES OR PERSONAL FRIENDS.) *

Name:

Street Address:

City, State, ZIP:

Phone Number:

Name:

Street Address:

City, State, ZIP:

Phone Number:

15. Where did you hear about this interviewing position? (PLEASE CHECK ALL THAT APPLY.)

Newspaper Ad?

Posted Ad?

Another interviewer (PLEASE SPECIFY INTERVIEWER'S NAME)

Some other source (PLEASE SPECIFY)

16. Why are you applying for this particular job? *

University of Illinois Survey Research Laboratory

FIELD INTERVIEWER AND SUPERVISOR APPLICATION FORM

( * Required Field )

University of Illinois
Survey Research Laboratory