YOUNG SCHOLARS PROGRAM
2014 SUMMER ACADEMY EMPLOYMENT APPLICATION
To be considered for employment, please submit this application and your RESUME to the Young Scholars Program.
The Ohio State University is an equal opportunity, affirmative action employer.
Women, minorities, Vietnam-era veterans, disabled veterans and individuals with disabilities are encouraged to apply.
PLEASE TYPE OR PRINT APPLICATION WITH BLACK INK
CURRENT RESUME MUST BE SUBMITTED WITH APPLICATION
Do you have a current, valid Driver’s License? ______ State______
Gender Male Female
Name___________________________________________________________________________________________
(Last)
(First)
(Middle)
Current
Address________________________________________________________________________________________
(Street)
(Apt. /P.O. Box)
(City)
(State)
(Zip Code)
Telephone
Numbers
(_____)__________________(_____)________________________________(_____)___________________________
(Home)
(Cell)
(Business)
Permanent (check & future correspondence will be mailed to this address)
Address________________________________________________________________________________________
(Street)
(Apt. / P.O. Box)
(City)
(State)
(Zip Code)
E-mail:_____________________________________________________________________________________
Education
If a Student, Circle Current Rank First Year Sophomore Junior Senior Graduate School Professional School
Are You Taking Summer Classes? Yes
No
(Please circle last year of formal education completed for each grouping)
Secondary School
College and/or Vocational School
Degree Received?
7 8 9 10 11 12
1 2 3 4 Assoc. BA MA PhD
Yes
No
Name and Location of School
Type of
Program of Major
RELEVANT EXPERIENCE
Degree
Coursework
(list any experience you have had
Received
working with youth)
Last High
School
College,
University,
Business,
Technical
or
Military
School
HOURS AVAILABLE TO WORK
Monday ________________________
Tuesday ________________________
Wednesday _____________________
Thursday _______________________
Friday _________________________
Saturday _______________________
Sunday ________________________
Graduate
School
Other
1
Have you ever been convicted of a criminal offense? Yes  No If yes, explain. A conviction will not necessarily be a
bar to employment. The nature of the offense, when it occurred and its relevance to this position will be considered.
________________________________________________________________________________________________
________________________________________________________________________________________________
Please indicate your relationship to The Ohio State University Office of Diversity and Inclusion Young Scholars Program.
Scholar
OSU Student (Non-Scholar)
Non-OSU Student
 General Public Non-OSU Faculty/Staff
OSU Faculty/Staff
2014 SUMMER EMPLOYMENT – Please limit your selection(s) to a maximum of TWO positions AND rank them in
order of preference.
Instructional Positions: (Master’s Degree or equivalent combination of education and experience preferred).
I am applying to teach:
 Writing Instructor
 Physics Instructor
 Chemistry Instructor
 Computer Science & Engineering Instructor
 Statistics Instructor
 College Pre-Calculus Instructor
 College Algebra Instructor
 Psychology Instructor
 Earth Science Instructor
 Scholar Mentor
Employment Experience
Summer 2014 OSU Employment: Will you have an additional position with The Ohio State University (or receive a paycheck
from another OSU department) during your appointment with the Young Scholars Program (i.e. Faculty, Staff, GRA, GAA,
Work Study, Student Wages, Other)?
Yes ( ) No ( ) If yes, specify the following:
OSU Job Title _____________________________ OSU Dept _____________________________
Percentage of Appointment ____________________
Business Office or Supervisor__________________________ Campus Phone_____________________________
Employment Experience
(1) Current or Most Recent Position:___________________________________ Dates: From (
Full Time ( ) Part Time ) (
/
) To (
/
)
Employer ________________________________ Department ____________________________________________
Address______________________________________ City __________________ State_______________ Zip _____
Description of Duties
________________________________________________________________________________________________
Supervisor ________________________ Phone _________________ Reason for Leaving _______________________
(2) Previous Position:_______________________________________________ Dates: From (
Full Time ( ) Part Time ( )
2
/
) To (
/
)
Employer ________________________________ Department ____________________________________________
Address______________________________________ City __________________ State_______________ Zip _____
Description of Duties
________________________________________________________________________________________________
Supervisor ________________________ Phone _________________ Reason for Leaving _______________________
Contacts: Please List Two References (non-family) and One Emergency Contact below. Be sure to include full name, address,
and phone number(s).
Emergency Contact
Reference 1
Reference 2
CERTIFICATION AND STATEMENT OF UNDERSTANDING 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 authorize the university to obtain information regarding my record with the Bureau of Motor Vehicles if the position for which I am applying requires driving. 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 the 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. The
University will pay the reasonable cost of any examination 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.
Signature ___________________________________ Print _________________________________
Date_______________________________
DO NOT WRITE IN THIS SECTION
RECOMMENDED ACTION
Hire  Do Not Consider
Status _____________________ Date Letter Sent_________________
Position __________________________________________________
If Hired, Specify Supervisor _____________________________ Length of Contract__________________________
Interview Date__________ Interview Time___________
Interviewer(s)___________________________________
Comments_______________________________________________________________________________________
References Checked_______________________________________________________________________________
Application Entered in System  Yes  No
Entered by ______________________Date __________
Rate of Pay__________________________________
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