Rutgers, The State University of New Jersey

STUDENT EMPLOYMENT OFFICE

Job Location and Development Program
Job Referral Form

This form must be completed after you have hired a Rutgers University student, or once
the position is no longer available.
Date: January 20th 2016

Company/Employer Name: Rutgers OIT

Name of Contact:
Contact Phone:

Jack Chen

Email: jcc@rutgers.edu

848-445-3995

Job Title (from posting):

Student Graphic Designer

Has the above position been filled?

If yes, did you hire a Rutgers University student?

Yes

No

Yes

No

If yes, please provide the following, which is required for federal reporting purposes:
Name of RU Student
Xin Wang

Start Date
2/8/2016

Would you like us to continue posting this job?

Hours/week
10-15

Yes

Hourly rate of pay

10.50

No

Assurance of Non-Discrimination
The undersigned states that it will not discriminate on the basis of race, religion, color, national
origin, ancestry, age, sex, sexual orientation, disability, marital status, or veteran status in the
employment of students of Rutgers University.
Name of Company: Rutgers OIT
Street Address:
City, State and Zip Code:
Name of Authorized Agent:
Date:
Please return to the Rutgers Student Employment Office by mail, fax at 732/932-0524 or
email jldp@ofa.rutgers.edu.
Revised 02/2013