Please fill in the following information regarding your EDUCATION:

If currently pursuing a degree, list number of credits earned:

Expected graduation date:

List any special schooling or training:

What are your plans for further study?

Are you a member of The Church of Jesus Christ of Latter-day Saints? Yes No

Ward: Stake:

Bishop: Bishop's phone #:

Have you served a mission? Yes No Where: When:

Current Church calling:

Previous callings:

Do you adhere to the standards of the Church and support it spiritually, intellectually, and financially? Yes No

Read and sign the following:

BYU-Idaho Code of Honor: Abide by the standards of Christian living taught by The Church of Jesus Christ of Latter-day Saints • Be
honest in all behavior • Respect personal rights of others • Respect property rights of others • Obey, honor, and sustain the law • Avoid
drug abuse • Comply with all BYU-Idaho regulations • Observe the Word of Wisdom • Live the law of chastity • Observe high
standards of taste and decency • Observe BYU-Idaho dress and grooming standards • Help others fulfill their responsibilities under
this code.

I have read the BYU-Idaho Code of Honor and accept it as a condition of employment. I also understand that eligibility for a temple
recommend is a specific condition of employment. I give BYU-Idaho permission to contact my Bishop and Stake President regarding my
eligibility for a temple recommend. I give BYU-Idaho permission to contact current and prior employers and references. I release from
all liability and hold harmless any person giving or receiving information. I understand that employment at BYU-Idaho exists at the will
of either party (employer or employee) for administrative and staff employees and may be terminated at any time and for any cause
whatsoever or for no cause, other than for reasons prohibited by law; faculty are hired on a contract basis.

Signature: Date:

The Campus Security Act of 1990 requires BYU-Idaho to provide information upon request to prospective employees concerning
campus crime statistics and campus security policies and procedures. To request this information, contact Human Resources at
(208) 496-1130 or view a copy of the report on the web at: www.byui.edu/DeanOfStudents/SafetyReport.htm

Name of College or
University

Years
Attended

Date
Earned