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The position I am applying for is:

Volunteer Coordinator (learn more)

Team Coordinator (learn more)

Corps Member (learn more)

The time I'm applying for is:

Monday and Wednesday 9:00am-12:00pm

Monday and Wednesday 2:30pm-5:30pm

Tuesday and Thursday 9:00am-12:00pm

Tuesday and Thursday 3:00 pm-6:00pm

**Please note the time you are applying for is throughout the entire academic year.

Biographical Information:

Last Name: First Name: Middle Initial:

Gender: Male Female

Date of Birth: Month Day Year

Permanent Address:

Street:

City: State: Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:

Phone:

School Address:

Street:

City: State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:

Phone:

Alternate/Cell Phone Number:

Email Address:

Year in school: Select One Freshman Sophomore Junior Senior

Major:

Race/Ethnicity (Optional):

Are you eligible for a work study award? Yes No

If yes, what is the size of your work study award?

Have you graduated from High School? Yes No

If so Where? (City and State):

Name of High School:

Have you earned a GED? Yes No

If so, where? (City and State):

If you have been convicted of a criminal offense, please describe the details including nature, circumstances, and date of the offense. 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.

Note: All applicants are subject to a criminal background check.

Are you legally eligible to work in the United States? Yes No

If you are a lawful permanent resident alien, please provide the following:

Registration Number:

Expiration Date:

Proof of citizenship or immigration status will be required upon acceptance. To enroll as an AmeriCorps member, you must be a U.S. citizen, U.S. National, or legal, permanent resident alien.

Short Answer:

List any experience you have previously had in working with young children, specifically any experience with children ages 3-5:

List any relevant coursework relating to young children that you have completed (Note: Lack of experience and coursework will not automatically disqualify you from a position with OSU Kid Corps.):

List and describe your extracurricular activities or community service in which you have previously been involved:

Do you speak any languages other than English? Yes No

If, yes which language(s) do you speak:

Specifically, what elements of the program excite you and attract you to want to become a member of OSU Kid Corps?

As an OSU Kid Corps Member, you will be working on a team of peers throughout the entire school year. Describe any past experience in working in a team atmosphere that you possess and include any potential pitfalls that you anticipate in working in a team setting.

Do you anticipate any potential issues with maintaining a consistent session time throughout the school year, keeping up on your hours throughout the year, or making a commitment for one full school year?

Yes No

If yes, explain:

List any previous employment that you have had and explain how you balanced that commitment with school and other extracurricular activities that you participated in:

References:

Please give the names and contact information of three references who would be willing to speak on your behalf. Note: Please include one past employer and do not include family members.

Reference 1:

Name:

Title:

Relationship:

Telephone Number(s):

Reference 2:

Name:

Title:

Relationship:

Telephone Number(s):

Reference 3:

Name:

Title:

Relationship:

Telephone Number(s):

Certification:

I certify that all of the information furnished in this 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 my past employment, military status, convictions, or other information to The Ohio State University and I further release any such 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 of false information included in the application materials or provided in the interview process can lead to the withdrawal of an offer or employment or to termination of employment. I understand that any future offer of employment may be conditioned upon the results of examinations, physical or other, 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 consideration.

By initialing below, I certify that I have read and agree with these statements.

Initials:

Date: Month Day Year

Click on the Submit button when you are finished filling out the application.