Please select the position(s) for which you would like to be considered (You may apply for one or more positions).

Junior Summer Institute- Explorations in Social Justice – High School Juniors (June 21-27, 2015)

Social Science/ Community Service Learning Instructor (6 positions available)

Samuel DuBois Cook Summer Academy – High School Seniors (July 5-11, 2015)

Writing Instructor (6 positions available)

Summer Bridge Experience – First year students entering Ohio State Autumn 2015 (August 8-21, 2015)

College English Instructor (4 positions available)

College English Tutor (4 positions available)

Personal Information

First Name / Last Name
Gender / Female Male / OSU Student ID # / OSU Name.#
Are you under the age of 18? / YES O / Do you have a current valid driver’s license? YES NO
Are you a U.S. citizen, permanent resident, or authorized to work in the U.S.? / YES NO

Current Address

Street Address / Address 2
City / State / Zip
Local Phone / Mobile Phone

Please indicate your relationship to The Ohio State University:

Young Scholar / OSU Student (Non-Scholar) / Non-OSU Student
General Public / Non-OSU Faculty/Staff / OSU Faculty/Staff
Are you currently employed by another OSU Department? YES NO
If yes, which department?
Will you be employed elsewhere on campus during any of the Young Scholars Summer Programs? YES NO
If yes, where will you be employed?
How many hours per week will you be working in your other position?
Enrollment Status / Full-Time Part-Time / Are you taking Summer Classes? / YES NO
Current Rank / Freshman / Master’s Student
Sophomore / Doctoral Student
Junior / Professional Student
Senior
College of Enrollment / Major
Expected Graduation Semester / AUSPSU / Expected Graduation Year / 201520162017201820192020
Are you currently employed as a GAA, GTA, and/or SRA? / YES NO
Have you ever been convicted of a criminal offense? / YES NO
If YES, you must provide details. A conviction will not necessarily be a bar to employment. The nature of the offense, when it occurred and its job-relatedness will be considered.

Emergency Contact Information

Street Address / Address 2
City / State / Zip
Mobile Phone / Relationship to you

Employment History

Dates of Employment / Is this position current? / YES NO
Employer Name
Employer Phone Number
Job Title/Description
Supervisor Name / Supervisor Title / Supervisor Phone
Dates of Employment / Is this position current? / YES NO
Employer Name
Employer Phone Number
Job Title/Description
Supervisor Name / Supervisor Title / Supervisor Phone

References

List two (2) references below that we may contact who are familiar with your work performance. Use personal references, (NOT relatives), ONLY if you have no employment references.

Name of Reference / Title of Reference
Street Address
City / State / Zip
Telephone / Email
How do you know this reference?
Name of Reference / Title of Reference
Street Address
City / State / Zip
Telephone / Email
How do you know this reference?

Certification and Statement of Understanding

NOTE: The University is required to verify identity and work authorization at the time of employment.

I certify that all of the information furnished in the employment application and its addenda are true and complete to the best of my knowledge. I understand that the university may investigate the information I have furnished. I authorize any person, firm, or organization to supply any information about me concerning any past employment, military duties, convictions, or personal information to the Ohio State University, and I further release any person, firm, or organization from any responsibility in disclosing such information, including from all liability for any damage that may result from furnishing such information to the university.

I realize that any misrepresentation or false information included in the application materials or provided in the interview process can lead to the withdrawal of an offer of employment or to termination from employment. I understand that any future offer of employment may be conditioned upon the results of examinations, physical or others, as may be necessarily required by the university. I understand that any future offer of employment may be conditioned upon the results of a background check as may be necessarily required by university. The university may pay the reasonable cost of any examination or background check which may be required.

The Ohio State University is a drug-free workplace. Individuals offered employment at The Ohio State University may be required to successfully complete a pre-employment physical which includes drug testing. Individuals who refuse to take or fail the drug test, after being informed, will be removed from employment consideration.

Signature / Date

1