OSU Kid Corps Member Application 2011-12
Please Return To:
OSU Kid Corps
29 West Woodruff Avenue, Ramseyer Hall Room 341
Columbus, Ohio 43210
The Position I am Applying to is: Team Coordinator
The Time I am Applying to 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.
Name (Last, First, Middle Initial):
Gender: Male Female
Date of Birth (Month/Day/Year):
City: State: Zip:
City: State: Zip:
Best phone number to contact you:
Year in school:
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 , if so Where? (City and State):
Name of High School:
Earned a GED , 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 it’s 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? (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.):
Yes , If you are a lawful permanent resident alien, please provide the following: Registration Number
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
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 your possess and include any
potential pitfalls that you anticipate in working on 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?;
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:
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.
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
By initialing below, I certify that I have read and agree with these statements.