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~"*~ <br />~~e~e~ara~~~a~~ <br />~~~r~~~st~, <br />COMMUNITY SERVICE LEARNING PROGRAM <br />EMPLOYMENT RECORD <br />Please return this form to: <br />Student Employment Office <br />ILB 1300 <br />Cleveland State liniversih- <br />121 Euclid Avenue <br />Cleveland, OH 4411 ~ <br />FAQ: (216) 687-9247 <br />(216)687-5577 <br />Student employment cannot begin and wages cannot be paid until this fog°m is ~~eturned to <br />the above add~~ess with app~ropt~iate sig~zatu~~es. <br />Student Name: <br />CSU student id: <br />Please complete the following employment information. <br />Agency (employer) Name: <br />Student's Job Title: <br />Starting Date: <br />Rate of Pay: (hourly) <br />Supervisor(s) authorized to sign time sheets. <br />Name(s) (typed): <br />Signatures: <br />I accept this work-study position and I understand that my Federal Work-Study award will <br />be reduced by the amount of wages earned under this employment agreement. By using <br />eligibility before the beginning of Fall term, I acknowledge that I am registered for Fall semester 2009 and <br />have every intention of attending. If for any reason I do not enroll and/or attend the fall ?009 academic <br />year, I will reimburse CSU for all wages ean~ed from May 17, ?009 through the date of termination of my <br />employment in this program. <br />Student Signature: <br />