Previous seven years Address(es): For what position(s) are you applying? Do you have any commitments (i.e., second job, school, etc.) which might interfere with, or adversely affect, your employment should we select you for a position? If yes, please explain:
Are you currently employed?
If so, may we contact your present employer?
If we cannot inquire of your present employer, please explain why:
Are you on layoff and subject to recall?
If employed, does your employment require you to continue working for your current employer, or restrict your activities after leaving your current employment, for any period of time? If yes, until what date? Are you prevented from becoming lawfully employed in the USA because of VISA or Immigration Status? (Proof of citizenship or immigration status is required by federal law upon employment.)
Do you possess a valid Driver's License?
Valid Commercial Driver's License?
If no, can you obtain an appropriate valid license prior to employment?
If the position you are applying for requires travel, can you supply your own transportation?
Have you been issued any other license, registration and/or certificate relating to the job(s) for which you are applying? If so, identify, indicate the field or area of specialization, the license/certification number, and when it expires.
Are you a resident of Ohio?
If not, are you willing to become a resident upon employment?
Are you a veteran of the U.S. Military Service?
Have you been convicted of a felony? If yes, describe below. (A conviction record will not necessarily be a bar to your employment. Factors such as age and type of offense, the seriousness and nature of the violation, and your rehabilitation will be taken into account.) EMPLOYMENT HISTORY AND WORK EXPERIENCE In this section, list all employment history and work experience in date order, including military experience. Begin with your current employer. Failure to include all employment may be grounds for disqualification. Upload additional document if necessary. Name & Address of Employer, Position, Reason for Leaving Name & Address of Employer, Position, Reason for Leaving Name & Address of Employer, Position, Reason for Leaving This section is intended to give the employer information about the education and training that the applicant has completed, and to demonstrate the skills, knowledge, and abilities of the applicant to perform the job duties of the position. High School: Name, location, did you graduate, what subjects did you study? Trade, Business, or Technical School: Name, location, did you graduate, what subjects did you study? College: Name, location, did you graduate, what subjects did you study? Other special study or research work: Name, location, did you graduate, what subjects did you study? Give the names of three persons not related to you whom you have known at least (1) year. Name, address & phone number, relationship & years acquainted. Name, address & phone number, relationship & years acquainted. Name, address & phone number, relationship & years acquainted. Please use the following space to provide any further information on training, education, certifications, skills, abilities, hobbies, volunteer work, etc., that you posses or have experienced that may be helpful in the evaluation of your application. Include special equipment and machines you can operate, name of computer software in which you have skill, and/or other relevant skills and abilities. APPLICANT'S CERTIFICATION AND AGREEMENT Please reach each o the following paragraphs carefully. Indicate your understanding of, and consent to, the contents and conditions of each paragraph by placing your initials at the end of each paragraph. If you have any questions regarding these paragraphs, contact the employer before initialing the paragraph.
1) I understand and accept that, depending upon the position for which I am applying, if I am employed by this agency, my employment may be for no definite period of time and may be terminated, with or without cause or notice at any time, at the option of either this agency, or myself. I undetstand that no representative of the agency, other than the Executive Director, has any authority to enter into any agreement or to make any agreement with me contrary to the foregoing.
2) I understand and accept that, if I am selected for employment, my initial and continued employment may be conditioned upon my passing any medical examination that that employer deems necessary to determine whether I can physically perform the essential functions of the position, with reasonable accommodation when necessary. I understand and accept that this may include drug, alcohol, or substance abuse testing.
3) If employed, I understand and accept that, depending on the unit and/or location for which i am applying for employment, I may be required to work evening or night shifts including weekends, be on call, and/or work mandatory overtime hours. I also understand and accept that I am required to abide by all rules and regulations of this agency.
4) I understand and accept that, if any information required in this application is found to be falsified or intentionally excluded, my application may be disqualified from further consideration. I further understand and accept that if I am employed by this agency, I may be subject to disciplinary action, including termination, if any information required by this application has been falsified or intentionally excluded.
5) I understand and accept that, the employer requires a high degree if integrity and confidentiality of its employees. I understand that the employer may use screening procedures to evaluate my qualifications and suitability for employment, including but not limited to interviews, criminal record checks, driving records checks, polygraph examination, written testing, reference checks, background investigations, psychological evaluations, and drug testing. I also acknowledge that I may be subject to other screening procedures not specifically listed above, and are a prerequisite to my appointment.
6) I hereby authorize the employers, schools, and personal references named in this application to provide information regarding me to the employer. I further authorize the release of personnel, academic, and other records to the employer. I solemnly swear that all of the information furnished in this employment application is true, accurate, and complete to the best of my knowledge. I authorize investigation of all statements contained in this application. I understand that any misrepresentation or falsification of the information provided may lead to withdrawal of an employment offer or termination following employment. I recognize that my future employment with the employer will be jeopardized if I engage in substance abuse, illegal drug abuse, or alcohol abuse. Therefore, in consideration of my employment application being reviewed and considered by this agency, I, being at least 18 years of age and under no legal disability on behalf of my heirs and assigns, hereby release and hold harmless this agency and any of its agents, employees, appointing authorities, related officials from any and all liability, whatever type and nature, resulting from the administration of any such screening procedures and/or release of the results therefrom. Submit