Name: (Last/First/Middle) RC ID#: Email Address: Telephone#: Campus Box#: Class:
Birthdate (MM-DD-YYYY): Are you part of the Federal Work Study Program?: Yes No Have you worked at Roanoke College before? Yes No
Have you ever been convicted of a Felony? Yes No (Employment could be contingent upon a background check.)
If yes, please explain below:
Position Applied for (check all for which you wish to apply):
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