Upper Sandusky, OH

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APPLICANT INFORMATION

First Name:*

Middle Name:

Last Name:*

Street Address:*

City:*

State:*

Zip Code:*

Phone:*

Email Address:*

Position Applying For:

Have you ever been employed by the City of Upper Sandusky?*

Yes

Desired Salary:

Tentative Start Date:

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EDUCATION

Highest Elementary / Secondary School Grade Completed*

High School Name & Location*

Graduation Status*

Enrolled

Graduated

G.E.D.

Did not graduate

Highest College Undergraduate Level Completed*

Institution Name & Location

Degree / Certification Earned

Area of Study / Major

Highest Graduate Level Completed*

Graduate School Name & Location

Degree Earned

Area of Study

Are you currently enrolled in an educational program?*

Yes

If yes, what is your current institution and course of study?

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LICENSES, CERTIFICATIONS, REGISTRATIONS

Do you possess a valid Driver's License or C.D.L.?*

Yes

If yes, what is the issuing state and License/C.D.L. number?

If you possess any additional licenses, certifications, or registrations, please enter them below. Please include the Credential Type/Name, Issuing State/Authority, License/Registration Number, and Expiration Date.

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MILITARY SERVICE

Were you, or are you presently in the US Armed Forces?*

Yes

If yes, what branch?

Dates of Service:

Served From:

Served To:

Rank:

Technical Specialization:

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AWARDS, HONORS, ACHIEVEMENTS, INTERESTS

Please list any awards, honors, achievements, volunteer or community service activities, special interests, hobbies, or any organizations of which you are/or have been a member. Please indicate any positions of leadership held.

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TRAINING AND OTHER QUALIFICATIONS

Please list any training you feel is relevant to the position for which you are applying. Please include the subject area of training, the name of the organization that provided the training, and the year the training was received.

Please use this area to briefly describe any additional information or special qualifications you have for the position for which you are applying. Please be sure to include any special machinery, office equipment, software, tools, vehicles, or other job-related items.

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EXPERIENCE

List your experience starting with your current/most recent employer. Please include all employment whether full-time, part-time, seasonal, or temporary during the past ten years. You may include additional experience beyond the past ten years if you desire and you are encouraged to do so if it is related to employment you are seeking. You may attach additional pages if necessary. Please do not use a resume as a substitute for completing this section, however, you may attach a resume to supplement the information contained within this employment application.

The City of Upper Sandusky may contact former employers. If you prefer that we do not contact your present employer until which time a conditional offer would be made, please check this box:

Current/Most Recent Employer:

Address:

Supervisor’s Name:

Phone Number:

Position Held:

Salary:

Date of Employment:

To:

Type of Employment:

Full-time

Part-time

Seasonal

Description of duties and responsibilities:

Reason for leaving:

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Previous Employer:

Address:

Supervisor’s Name:

Phone Number:

Position Held:

Salary:

Date of Employment:

To:

Type of Employment:

Full-time

Part-time

Seasonal

Description of duties and responsibilities:

Reason for leaving:

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Previous Employer:

Address:

Supervisor’s Name:

Phone Number:

Position Held:

Salary:

Date of Employment:

To:

Type of Employment:

Full-time

Part-time

Seasonal

Description of duties and responsibilities:

Reason for leaving:

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REFERENCES

Please list three individuals, other than relatives, whom we may contact as references regarding your character, ability, or experience.

1st Reference:

Name:

Phone Number:

Type of Reference:

2nd Reference:

Name:

Phone Number:

Type of Reference:

3rd Reference:

Name:

Phone Number:

Type of Reference:

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CERTIFICATION AND STATEMENT OF UNDERSTANDING

I certify that all of the information furnished in this employment application and its addenda is true and complete to the best of my knowledge. I understand that the City of Upper Sandusky, may investigate the information I have furnished and realized that any misrepresentation or false information in this application and its addenda may lead to withdrawal of any employment offer or termination after employment.

Full Name:*

Date:*

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ACKNOWLEDGMENT & RELEASE

I hereby acknowledge that I, voluntarily and of my own free will, have applied for employment with the City of Upper Sandusky, with the understanding that the City may use a variety of screening procedures to evaluate my qualifications and suitability for appointment. I have been advised that these screening procedures may include, but are not limited to, interviews, criminal record checks, driving record checks and reference checks. I also acknowledge that I may also be subject to other screening procedures, not specifically listed above. I further acknowledge that any such screening procedures, as reasonably required by the City of Upper Sandusky, are a prerequisite to my appointment to a position with the City of Upper Sandusky.

In addition, I also hereby understand that the City of Upper Sandusky, cannot guarantee the confidentiality of the results of, or information obtained through, the aforementioned screening procedures. Rulings of the Ohio Supreme Court relative to the Public Records Act indicate that, with certain enumerated exceptions, records, maintained by a governmental entity are a matter of public record and, should a proper request be made by a member of the public for such records, the governmental entity would be required to make such records available to that member of the public within a reasonable period of time. Employment-related documents, with the exception of medical records, attained by the City relative to the aforementioned screening procedures do not appear to fall within any of the enumerated exceptions.

Full Name:*

Date:*

Days	Hours
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

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APPLICANT INFORMATION

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EDUCATION

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LICENSES, CERTIFICATIONS, REGISTRATIONS

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MILITARY SERVICE

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AWARDS, HONORS, ACHIEVEMENTS, INTERESTS

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TRAINING AND OTHER QUALIFICATIONS

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EXPERIENCE

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REFERENCES

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CERTIFICATION AND STATEMENT OF UNDERSTANDING

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ACKNOWLEDGMENT & RELEASE

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APPLICANT INFORMATION

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LICENSES, CERTIFICATIONS, REGISTRATIONS

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MILITARY SERVICE

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TRAINING AND OTHER QUALIFICATIONS

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EXPERIENCE

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REFERENCES

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ACKNOWLEDGMENT & RELEASE

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