Online Application Form
Section I - Personal Information
Name
*
Street Address
*
City, State, Zip
*
County
*
Home Phone
Work Phone
Are you at least 18 years old?
Yes
No
If under 18, can you obtain a work permit?
Yes
No
Are you a citizen of the United States?
Yes
No
Do you have any physical, mental or medical impairment that will interfere with your ability to perform the job for which you are applying?
Yes
No
If yes, please explain
Section II - Work Preferences
Please describe in one or two sentences the type or nature of work you are looking for
Do you need
Please Select One
Full Time Work
Part Time Work
Are you interested in
Please Select One
Permanent Work
Temporary Work
Intermittent Work
Seasonal Work
No Preference
What is your minimum salary requirement?
Date available to start
(example: 2/15/2009)
Section III - Work Experience
Please describe your work experience (be sure to include United States military experience or prior public service work) by completing the spaces on this section. Begin with your
most recent
employer.
May we contact these employers for references?
Yes
No
Employer's Name
Street Address
Supervisor's Name
Dates Employed
Job Title, Beginning and Ending
Salary, Beginning and Ending
Describe your duties, responsibilities, equipment operated, ect. for position(s) held
Describe your reason(s) for leaving
Employer's Name
Street Address
Supervisor's Name
Dates Employed
Job Title, Beginning and Ending
Salary, Beginning and Ending
Describe your duties, responsibilities, equipment operated, ect. for position(s) held
Describe your reason(s) for leaving
Employer's Name
Street Address
Supervisor's Name
Dates Employed
Job Title, Beginning and Ending
Salary, Beginning and Ending
Describe your duties, responsibilities, equipment operated, ect. for position(s) held
Describe your reason(s) for leaving
Employer's Name
Street Address
Supervisor's Name
Dates Employed
Job Title, Beginning and Ending
Salary, Beginning and Ending
Describe your duties, responsibilities, equipment operated, ect. for position(s) held
Describe your reason(s) for leaving
Employer's Name
Street Address
Supervisor's Name
Dates Employed
Job Title, Beginning and Ending
Salary, Beginning and Ending
Describe your duties, responsibilities, equipment operated, ect. for position(s) held
Describe your reason(s) for leaving
Section IV - Educational Experience and Training
Please select the last year of formal education you have completed
Please Select One
1
2
3
4
5
6
7
8
9
10
11
12
Name of school
Address
College
Please Select One
1
2
3
4
5
6
7
Technical School
Please Select One
1
2
3
4
Other (please explain)
If a graduate, please state degree(s)
Please describe the courses you took or technical training you have received from school which you feel would help you perform the job for which you are applying (include special machines or equipment you operate, hobbies, or volunteer work projects which have taught you qualifying skills, ect.)
Section V - Miscellaneous
Do you have any commitments which might interfere with or adversly affect your employment with the county? (Exclude commitments which might indicate race, age, color, religion, sex, hational origin, or physical handicap)
Yes
No
If yes, please explain
Do you presently have or are you willing to obtain a valid State of Ohio Driver's License (CDL)? (This information will be considred for selection purposes if such licensure is required by law to perform the duties of the position for which you are considered.)
Yes
No
Have you filled an application here before?
Yes
No
Have you ever been employed here before?
Yes
No
Give the name, address and phone number of three references not related to you
Reference 1
Name
Address
Phone
Reference 2
Name
Address
Phone
Reference 3
Name
Address
Phone
Have you ever been convicted of or pleaded guilty to a criminal offense?
Yes
No
If yes, please explain
I solemly swear that all of the information furnished in this Employment Application is true, accurate and complete to the best of my knowledge. I understand that any misrepresentation or falsification of the information provided may lead to withdrawal of an employment offer or termination following employment.
Name
*
Date
*
(example: 2/15/2009)
*
Required Field
