MDIBL: Seasonal Personnel Application

MDIBL Personnel Application

INSTRUCTIONS: This application is mandatory for all personnel associated with a PI at MDIBL. Each member of the lab group listed on the PI's application must fill out this form and submit it as soon as possible. PIs renting lab space should complete the PI Housing Application Form.

For more information, please contact:

Charles Wray, Ph.D.
Associate Administrative Director
MDI Biological Laboratory
Old Bar Harbor Road (Fed Ex Address)
PO Box 35
Salisbury Cove, ME 04672
207-288-2130 (fax)
207-288-9880 ext 125 (phone)
science_apps@mdibl.org

Seasonal Personnel Application - 2008

I. Personal Information and Addresses

First Name*

Middle Initial

Last Name*

Social Security Number

Date of Birth*

Email Address*

Investigator with whom you will work*

Academic Rank*

Academic Rank Other:

Degree*

Degree other:

Home Address*

City*

State*

Zip*

Country*

Home Telephone*

Mobile Telephone

Citizenship*

Institution*

Institutional Address*

City*

State*

Zip*

Country*

Institutional Telephone*

Institutional Fax

Preferred mailing address*

II. Dates of residence

Please indicate your requested dates of residency*

Arrival: Departure:

Please indicate any anticipated absences from MDIBL during this period.

III. Housing

If you are an undergraduate or high school student, do not indicate housing preference below. You will be assigned to an undergraduate or high school-specific dormitory.

If you are a graduate student, postdoctoral fellow, professional technician, or associate scientist, please indicate the number of people in residence and indicate your housing preference below (in order: 1, first preference, 2, second preference, ect.). Please browse the Laboratory Grounds site for housing descriptions and information.

If you are applying as a PI you should not complete this form. Please complete the PI Housing form.

If you plan on bringing a pet, you must complete the Pet Application.

Type	Number of People	Dorm	Oaks/Emery	Apartment	Cottage
Graduate Student
Postdoctoral Fellow
Professional Technician
Associate Scientist

Key:

Applicant housing only, no pets

Spouse, partner, and family residence permitted, no pets

Spouse, partner, and family residence permitted, pets permitted with application

Dorm: Mixed gender building; double occupancy bedrooms; shared bathrooms; no kitchen facilities
Oaks: Mixed gender building; four double occupancy bedrooms with private bath shared with roommate; one shared kitchen/living room
Emery: Mixed gender building; four double occupancy bedrooms with shared bath; two single occupancy bedrooms with private bath; one shared kitchen/living room
Apartment: Single or small family accommodation; single private bedroom, bath, kitchen
Cottage:Family accommodation; mulitple private bedrooms, bath, kitchen

IV. Certification

I agree to pay a $100 housing security deposit with the acceptance of housing award and to pay rent in full prior to tenancy unless other arrangements have been made.

I accept the terms and conditions stated above and certify that all the information entered on this form is complete and accurate.*

Applicant:* Date:*