Business Office: (608) 262-1688
Hiring & Staffing Office: (608) 262-2076
Field Office: (608) 263-0860
Fax: (608) 262-8432

The University of Wisconsin Survey Center

University of Wisconsin - Madison
475 N Charter Street
RM 4323
Madison, WI 53726

Survey Research Interviewer Online Application

Applicants must be 18 years of age or older and have a high school diploma or equivalent. Incomplete applications will not be considered. If there is a reason you cannot complete portions of this application, please explain in the space provided at the end of the application.


What is your full legal name?

First Name:
Middle Initial:
Last Name:

What is your address and telephone number?

Street Address:
Apartment Number:
City:
State:
Zip Code:
Telephone Number:--

Is this a cell phone?
Yes
No

What is your Email Address?

Are you a U.S. Citizen?
Yes
No

Are you a Wisconsin Resident?
Yes
No


WORK AVAILABILITY

When can you begin working? (MM/DD/YYYY)

When must you stop working? (MM/DD/YYYY)
(If not applicable, leave blank.)

A minimum of 3 shifts (12 hours) per week is required; generally evenings/weekends and one shift must be a weekend shift. Occasionally we need staff primarily for weekday shifts (this may be telephone work or Tracing and Locating work).

Number of hours per week you'd like to work:

When are you primarily available to work?
(check all that apply)
Weekdays
Weeknights
Weekends

We are also looking for a small number of interviewers to conduct interviews in Spanish. How would you describe your fluency in Spanish?
(check all that apply)
Speaking Fluency
Writing Fluency
Not fluent/Does not apply


EDUCATION AND EXPERIENCE

What is the highest year of school that you have completed?

Are you currently a student?
Yes
No

Are you currently a University or State employee?
Yes
No

Were you ever previously employed by the University of Wisconsin or the State of Wisconsin?
Yes
No

Have you previously worked for the UW Survey Center?
Yes
No

Are you able to type?
Yes
No

Please briefly describe any special skills or knowledge you have, such as foreign language fluency, computer experience, or internships:


PAST EMPLOYMENT

Please list your last four employers, starting with your current or most recent employer first:

Also include your supervisors' reference information from all jobs listed above. Applications with incomplete references will not be considered. Indicate any discrepancies in the comments section at the end of the application.

JOB 1

Name of Business:
Position Held/Job Title

Start Date:
End Date:
(Leave end date field blank if currently working)

Did you work Full-time or Part-time? Full-time Part-time

REFERENCE

Name
Title
Telephone Number--

JOB 2

Name of Business:
Position Held/Job Title

Start Date:
End Date:
(Leave end date field blank if currently working)

Did you work Full-time or Part-time? Full-time Part-time

REFERENCE

Name
Title
Telephone Number--

JOB 3

Name of Business:
Position Held/Job Title

Start Date:
End Date:
(Leave end date field blank if currently working)

Did you work Full-time or Part-time? Full-time Part-time

REFERENCE

Name
Title
Telephone Number--

JOB 4

Name of Business:
Position Held/Job Title

Start Date:
End Date:
(Leave end date field blank if currently working)

Did you work Full-time or Part-time? Full-time Part-time

REFERENCE

Name
Title
Telephone Number--


Please tell us how you heard about the UW Survey Center:

Please use the box below for any comments or questions.


Contact UW Survey Center with any comments or questions.