2014 OCSP Summer Staff Application

Applicant Information

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

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

Pathfinders S1
Achievers Summer Academy
Pathfinders S2

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:
Have you ever been convictioned of, or are you currently charged with a crime? (yes/no):
(A prior conviction does not automatically disqualify you from employment and the information you provide will be considered only if relevant to the position)

If yes, please explain: Put N/A if you have no conviction.

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:

Name of High School: Major(s):

Please provide a reference:

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

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

Work Experience:

Place of Employment:
Phone Number:
Job Duties:
Start Date: End Date:
Name of Supervisor:

Emergency Contact Information

First Name: Last Name:
Home/Cell Phone:
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: