MCC Student Associate (SA)Application

(Note: you must be an OSU student to be a Student Associate at The Ohio State University Multicultural Center. For volunteer or academic practicum opportunities, please contact the MCC at 614.688.8449 for additional information)

Personal Information

Name:

______

Last First Middle

Permanent Mailing

Address: ______Address:______

Number and Street Number and Street

______

City State Zip City State Zip

Phone: ( ) ( ) ( )

Permanent Phone Local Phone Cell Phone

Email: ______

OSU/Buckeyemail (Name.#) Preferred Email

Academic

Information: ______(Qtr) (Yr)

Major (and Minor, if applicable) Yr/Rank Expected Graduation Date

Employment History

Have you worked for OSU previously or are currently employed at the University? Yes/No

If yes, list departments and dates of employment (MM/YY)? ______

Below please record your past employment history, including OSU employment and non-University employment:

Employer/Department / Supervisor Name / Supervisor’s Phone number: / Start & end date
Supervisor’s Email:
Job duties and skills:
Employer/Department / Supervisor Name / Supervisor’s Phone number: / Start & end date
Supervisor’s Email:
Job duties and skills:
Employer/Department / Supervisor Name / Supervisor’s Phone number: / Start & end date
Supervisor’s Email:
Job duties and skills:

MCC Student Associate (SA) Application

Short Answer Questions:

Please answer the following questions in approximately 100 words or less:

  1. What attracts you to working at the MCC?

2. What skills and abilities do you hope to gain by working at the MCC?

References:

Please provide contact information for two individuals who can speak to your ability to provide superior customer service (i.e., employment references preferred):

1. ______

Name Title Office/Department

______

Phone Email Relationship to You

2. ______

Name Title Office/Department

______

Phone Email Relationship to You

Additional Information:

Have you ever been convicted of a criminal offense? Yes/No

If yes, you must provide details to the hiring manager. 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.

Please include with this application the following 2 things:

1. A copy of your academic schedule (print from Buckeyelink)

2. A listing of the days and hours you are typically available to work:

Approximately how many hours would you like to work per week: ______to ______

Certification of Information

I certify through my signature below that all information provided in this document is truthful and honest to the best of my knowledge:

______Signature Print Name Date

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