Career Services
Work-Study Application
Student Information
Is this a new application or an update?
New Application Update
Campus Selection: Springfield Greene Center Ohio High-Point Career Center Xenia
Name: _____________________________________ Student Identification Number: ___________________________
ddress: _________________________________________________________________________________________
Phone: ________________ Alternate Phone: ________________ Clark State Email: ___________________________
Major: ________________________________________ Number of credit hours enrolled: _______ GPA:___________
Position(s) of Interest: ______________________________________________________________________________
Relevant coursework completed (i.e. computer, office administration, technical classes
Job related/special skills (computer skills, office skills, typing speed, etc.) obtained from previous employment or
Are you a Federal Eligible Work-Study? Yes No If Yes, Federal Amount: _________ Financial Aid Initials: ____
Are you 18 years old or older? Yes No
If you are under the age of 18, can you provide proof of your eligibility to work? Yes No
Requisite Coursework
For Tutor or Supplemental Instructor Applicants Only
For what position are you applying?
Peer Tutor – Minimum of 4 hrs/wk (Requires 2.5 GPA and A or B in the course you plan to tutor)
Success Center Tutor – 18 hrs/wk (Same as above AND completion of ENG 1111, ITS 1105, CPE 0500, 0600, 0700 or
equivalent COMPASS score)
What subject(s) would you like to tutor? ___________________________________ Grade in that subject(s):
_______ .
Current Cumulative GPA: _____
Prior Work Experience
1. Employer: __________________________________________ Employment Dates ____ / ____ through ____ / ____
mm / yy mm / yy
Position Title: ____________________________________________________________________________________
Description of Duties: _____________________________________________________________________________
Career Services
Clark State Community College
570 East Leel Lane
Springfield, OH 45505
Career Services
Sara T. Landess Technology and
Learning Center, Room 105
Financial Aid Oce
Leel Lane Location
Greene Center
Federal Eligible
College Only
Career Services
2. Employer: __________________________________________ Employment Dates ____ / ____ through ____ / ____
mm / yy mm / yy
Position Title: ___________________________________________________________________________________
Description of Duties: _____________________________________________________________________________
3. Employer: __________________________________________ Employment Dates ____ / ____ through ____ / ____
mm / yy mm / yy
Position Title: ___________________________________________________________________________________
Description of Duties: _____________________________________________________________________________
1. Name: _____________________________________________ Phone Number: _______________________________
Relationship to Applicant (No relatives please): _______________________________________________________
2. Name: _____________________________________________ Phone Number: ______________________________
Relationship to Applicant (No relatives please): _______________________________________________________
Other Information
Have you ever been employed by Clark State before? Yes No
If yes, give dates and department(s): __________________________________________________________________
Have you ever been convicted of or plead guilty to a misdemeanor or felony? Yes No
If yes, you must explain the details of the oense to the Career Services Specialist before being considered for a position.
A conviction will not necessarily be a bar to employment. Each instance will be considered in relation to the position for which you apply.
By e-signing below, I certify that all the information provide in this application is true and I have not knowingly
withheld any facts that might aect the College’s decision to hire me or maintain my employment.
I also acknowledge that I understand the following:
I must be registered for at least six credit hours at Clark State Community College and must be at least16 years old to
be eligible for on-campus employment.
Completing an application does not guarantee an oer of employment.
In the event that I am employed by Clark State Community College, I will be required to show proof of eligibility for
employment in the United States.
As an employee of Clark State Community College, I am required to abide by all College policies and procedures.
Any false or misleading information given in my application or interview(s) may result in my being discharged.
After being extended an oer to work at Clark State Community College, a background check may be required prior
to employment.
All Positions end at the end of Summer Semester and oces will re-evaluate stang needs at that time.
E-Signature: ____________________________________________________________ Date:
It is your responsibility to contact Career Services if you are no longer interested in on-campus employment.
Otherwise we will continue to circulate your application for available positions throughout the semester. An updated
application and contact information form is required each semester if you are still interested in employment at
Clark State Community College. Consult with the Financial Aid Oce to determine how work-study will aect your
financial aid award.
Contact Career Services: 937.328.6472 |
Career Services does not make hiring decisions for most positions.
Qualified applicants are forwarded to work-study supervisors, who make hiring decisions for their own departments.