Tutoring Program Application Form
Student Instructional Assistant / Tutor
The Ohio State University
Office of Minority Affairs
Academic Advancement Services

General Information

Social Security # *
First Name *
Middle Name
Last Name *
OSU Email: *
Address:
City:
State:
Zip:
Phone: (format 555-555-5555)
Student Standing
Graduation Month/Year: * (format mm-yyyy)
Cumulative GPA: *
College
Major *
Have you ever been convicted of a felony? *
If so, please disclose:
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.
Please list the courses you are interested in tutoring in order of preference (Example: Math 150, Spanish 101-102.66, etc.). 1.
2.
3.
4.
5.
6.
Leadership Activities:
List any service organizations and/or activities for which you have participated. Specifically note leadership positions you have held in association with the organizations and/or activities.
 
Advising Report:

In order to verify course grades and minimum GPA requirement, each applicant must submit a university advising report, or a copy of an official college transcript. If you have transfer credit(s) from another college or university for the courses you wish to tutor, you must submit a copy of the transcript from the institution where you received the credit(s). University advising reports may be accessed in electronic format on the following webpage http://buckeyelink.osu.edu/advising_degree.html.

Instructions:

1. Click on the Browse button and locate your saved copy of your advising report.
2. Highlight the file and press Open.

Demographic Information

Submission of demographic data is voluntary and will be used for statistical purposes only. This information will not be used in the hiring process.

Gender
Ethnicity:
Age Group:

Section II: Employment

If hired as a tutor, will you also be employed elsewhere at OSU? *
If so, where will you be employed:
# of Hours / Week:
Are you currently employed as an OSU Graduate Teaching Assistant (GTA) or Graduate Administrative Associate (GAA)? *
If so, which department:
Employment History: Please list in chronological order your last 3 positions.
Employer 1:
Dates of Employment:
Employer:
Supervisor Name & Phone #:
Reason for Leaving:
Employer 2:
Dates of Employment:
Employer:
Supervisor Name & Phone #:
Reason for Leaving:
Employer 3:
Dates of Employment:
Employer:
Supervisor Name & Phone #:
Reason for Leaving:

Section III: References

Please provide references which can comment on your ability to tutor. You must include at least one university professor, teaching assistant, or staff member. If listing a reference outside of the United States, only the email address is necessary. Please do not include relatives.

Reference 1:
Name:
Title:
Association:
Length of Association:
Phone:
Email:
Reference 2:
Name:
Title:
Association:
Length of Association:
Phone:
Email:
Reference 3:
Name:
Title:
Association:
Length of Association:
Phone:
Email:

Section IV: Certification & Statement of Understanding:

I certify that all information provided in the application is true and complete to the best of my knowledge. I understand the OMA Tutoring Program may investigate the information I have provided. I authorize any person, firm, or organization to release information about me regarding past employment, convictions, or personal information to the OMA Tutoring Program. I further release any person, firm, or organization from responsibility in disclosing such information, including from liability for damage that may result from furnishing such information. I understand that misrepresentation or false information provided in the application materials or the interview process can lead to the withdrawal of an offer of employment or termination of employment. I understand any future offer of employment may be conditioned upon the results of a background check as may be necessarily required by the OMA Tutoring Program. The OMA Tutoring Program will pay the reasonable cost of any background check which may be required.

I agree