2013 OCSP Summer Camp Staff Application-Open


Applicant Information

*Note: Applicants MUST mail in the most recent copy of their transcript. A GPA of at least 2.5 is required.


Which program(s) would you like to apply for?

Pathfinders
Achievers Summer Academy
Camp S.O.U.L.


Tell us about yourself:

First Name of applicant: Last Name:
Street address:
City: State: Zip code:
Phone number: Cell Phone:
What are your interests and hobbies?:

Are you involved in any clubs/organizations?:
Gender: Are you over 18 (yes/no): GPA:
E-mail:

Have you ever been convictied of a crime? (yes/no):

If yes, choose one of the following:
misdemeanor felony

Do you have driver's license? (yes/no):
Are you legally authorized to work in the United States? (yes/no):
Are you a graduate student or undergraduate?:
T-Shirt Size:

Small
Medium
Large
X-Large
XX-Large
XXX-Large
Name of High School:
City and State of High School:
Year Graduated: Name of College:
Expected Graduation Date:
Major(s): Minor(s):


Please provide three references:

1) Name: Relationship:
E-mail Address: Phone Number:

2) Name: Relationship:
E-mail Address: Phone Number:

3) Name: Relationship:
E-mail Address: Phone Number:


Work Experience:

1.) Place of Employment:
Phone Number:
Address:
Job Duties:
Start Date: End Date:
Name of Supervisor:

2.) Place of Employment:
Phone Number:
Address:
Job Duties:
Start Date: End Date:
Name of Supervisor:

3.) Place of Employment:
Phone Number:
Address:
Job Duties:
Start Date: End Date:
Name of Supervisor:

Please read and initial the following statement:


All offers of employment, oral and written, shall include the following statement: “This offer is contingent on the university’s verification of credentials and other information required by state law and IU policies, including the completion of a criminal history check.” I certify that all information provided in all my application material is true. I understand that any false statement made herein is sufficient reason for rejection of this application or termination of subsequent employment regardless of date of discovery. I authorize the University to investigate all statements made in my application material for employment. I authorize such educational institutions and employers and others (and their agents or employees) to respond to questions concerning information given in this application material and I further release from liability such former employers, institutions, or persons providing such information to the University.

Indiana University complies with the Drug-Free Workplace Act of 1988 and the Drug-Free Schools and Communities Act Amendments of 1989. The unlawful manufacture, sale, distribution, dispensation, possession or use of a controlled substance (usually referred to as illegal drugs listed under the federal Controlled Substances Act) and alcohol is prohibited on University property, or in the course of a University activity, and may result in employee discipline up to and including termination of employment.

I understand that direct deposit of my paycheck to my personal checking or savings account is a condition of employment. I understand that no offer of benefits such as a pension plan, insurance, vacation or salary rate is final until cleared by Human Resources, and fully approved by appropriate University officials.

To agree to the terms above, place your initials here:
Date: