Fillable Check for Civil Service Exam Application Check for (City of Cleveland)

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Check for Civil Service Exam Application Check for (City of Cleveland)

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  • 38 check-boxes
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U.S.A. forms for City of Cleveland

BROWSE CITY OF CLEVELAND (OH) FORMS

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Check for Civil Service Exam Application
Check for Employment Application
City of Cleveland
Department of Human Resources and Civil Service Commission Application
601 Lakeside Avenue
Cleveland, Ohio 44114
http://www.city.cleveland.oh.us Job Hotline: (216) 664-2420
It is the policy of the City of Cleveland to provide equal opportunity in employment and advancement to all
qualified individuals without regard to race, color, religion, age, sex, national origin, ancestry, disability, genetic information, or sexual
orientation. Discrimination is prohibited by federal law, state law, and City Ordinance.
TO BE CONSIDERED FOR EMPLOYMENT:
1) Fill out application completely and answer every question fully; 2) Do not put “refer to resume”; 3) Be sure to sign and date
the application.
PERSONAL INFORMATION
Last Name
First Name
M.I.
Social Security Number
Address
State
County
Zip
Phone Number – Day Time
E-mail Address:
Do you have any relatives who are currently employed by the City of Cleveland? Yes No
Name: Department:
Are you eligible to work in the U.S.? Yes No Are you over 18 years old? Yes No
EMERGENCY CONTACT
Name
Address
City
State
Zip
Home/Business Phone
Relationship to you:
TYPE OF WORK DESIRED
Position Applied For: Salary Required: Date Available:
If this position requires, can you provide a Valid State of Ohio Driver’s License or Commercial Driver’s License? Yes No
If this position requires, do you own or have access to a properly registered and insured vehicle? Yes No
If interested in summer work, check ONLY this box: |Full-time| |Part-time| |Seasonal| |Overtime| |Holidays|
Otherwise, if required, are you available to work: Yes No Yes No Yes No Yes No Yes No
OFFICE USE ONLY
Application Approved
Application Disapproved
By
By
Reason(s)
Date
Date
EMPLOYMENT HISTORY
List your present and most recent employer first. Include periods of time for the past ten (10) years* whether employed or unemployed, including
volunteer work and active military service (use additional forms, if necessary) DO NOT USE “REFER TO RESUME”
*Note: The Civil Service Commission recognizes and credits applicants who provide more than ten years on their Civil Service Exam application.
Name of Employer
Immediate Supervisor
Start Date
End Date
Employer Address
Employer Phone Number
Starting Position
Current/Ending Position
Starting Wage
Ending Wage
Was this
position:
Full-time
Part-time (# of hours per week)
Paid
Volunteer (# of hours per week)
Description of Your Duties:
Reason for Leaving:
Name of Employer
Immediate Supervisor
Start Date
End Date
Employer Address
Employer Phone Number
Starting Position
Current/Ending Position
Starting Wage
Ending Wage
Was this
position:
Full-time
Part-time (# of hours per week)
Paid
Volunteer (# of hours per week)
Description of Your Duties:
Reason for Leaving:
Name of Employer
Immediate Supervisor
Start Date
End Date
Employer Address
Employer Phone Number
Starting Position
Current/Ending Position
Starting Wage
Ending Wage
Was this
position:
Full-time
Part-time (# of hours per week)
Paid
Volunteer (# of hours per week)
Description of Your Duties:
Reason for Leaving:
Name of Employer
Immediate Supervisor
Start Date
End Date
Employer Address
Employer Phone Number
Starting Position
Current/Ending Position
Starting
Wage
Ending Wage
Was this
position:
Full-time
Part-time (# of hours per week)
Paid
Volunteer (# of hours per week)
Description of Your Duties:
Reason for Leaving:
MILITARY SERVICE RECORD
Branch of Service
Discharge Date and Rank
Type of Discharge
Time Served
Are you currently on active duty? If yes, please provide current pay stub or Leave Earning Statement (LES) Yes No
* You must attach discharge papers, DD214 and/or other proof of services to receive credit if applicable.
REFERENCES
Please list names and addresses of persons we may contact for a professional recommendation (Do not list relatives)
Name & Address
Telephone Number
Name & Address
Telephone Number
Name & Address
Telephone Number
EDUCATION & TRAINING
Name of School, City & State Dates attended Degree and Major
High School*
Business/Technical School
College/University
Graduate School
Other
* If you did not graduate, did you receive a G.E.D.? Yes No
Use this space for an explanation of additional skills, tools, licenses or specialized training you have received:
List computer software you can use proficiently:
Typing words per minute:
APPLICATION WILL NOT BE ACCEPTED IF THIS AFFIRMATION IS OMITTED
I affirm that the answers I have made to each and all of the questions in this application are complete and true to the best of my
knowledge and belief, and that intentional deception herein may be considered as sufficient cause for disqualification or dismissal if
employed. I hereby waived all provisions of law forbidding my physician or other person who has attended or examined me or who
may hereafter attend or examine me, colleges or universities which I attend, or past employers, from disclosing any knowledge or
information which they thereby acquired relevant to my employment and I hereby consent that they disclose such knowledge or
information to the City of Cleveland. I hereby also consent to the release of all my police records concerning any arrest with
subsequent convictions for crimes. I release these records to City of Cleveland, and waive any right to personal privacy I might have
over the records.
I am applying for employment with the City of Cleveland. I understand that if employed, I agree to conform to the rules of the City of
Cleveland. I also agree that I shall be subject to other conditions which the City of Cleveland may adopt.
“I affirm under oath, the statements made by me in this application are true, complete and correct to the best of my knowledge, and
that I am aware that any false statement may be sufficient cause for termination from employment with the City, exclusion
from any examination and/or the removal of my name from any eligible list established by the Cleveland Civil Service Commission
as a result of an examination.”
Signature of Applicant: Date:
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signature
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AUTHORIZATION TO DO BACKGROUND CHECK FOR RELEASE OF CONFIDENTIAL INFORMATION
AND WAIVER OF PRIVACY RIGHTS
Please read the following before signing:
I,____________________________________, hereby authorize the City of Cleveland and its agents or employees to
(Name of employee or prospective employee)
conduct a background check on me and authorize the release of pertinent information concerning me from any source,
including, but not limited to, past employers.
The undersigned applicant, in granting this application, hereby specifically WAIVES any right to PERSONAL PRIVACY he or
she might have in the above information and RELEASES the City of Cleveland and any person or agency from ANY
LIABILITY WHATSOEVER resulting from the release of such information.
NOTE: Public Law 91-508 requires that we advise you that a routine inquiry may be made which will
provide applicable information concerning character, general reputation, and personal characteristics.
ROUTINE INQUIRIES MAY INCLUDE PERSONAL INTERVIEWS WITH FRIENDS, NEIGHBORS, REFERENCES
AND PAST EMPLOYERS. Upon written request, additional information as to the nature and scope of a
resulting report, if one is made, will be provided.
My signature below certifies that my responses on the Application for Employment/Civil Service Test Application are true
and complete to the best of my knowledge. I understand that employment is based on completion of all pre-employment
requirements and procedures which may include:
1. Interviews
2. Urine drug screen and pre-employment physical
3. Proof of identity and employment eligibility for work in the U.S.
4. Education and reference checking
5. Testing (if applicable to the position for which you are applying)
6. Criminal and motor vehicle record check
7. Consumer report check
In addition, I understand that any offer of employment will be contingent upon the results of a physical
examination by authorized medical personnel of or for the City of Cleveland.
Compliance with the City of Cleveland’s Drug Testing Policy is a condition of employment. Therefore, all
job offers are made with the understanding that prospective employees pass a drug screening test prior to
being hired.
I understand and agree that any falsification or omission, either on this form or in response to questions
asked during my interview or examination process or on employment forms I subsequently complete,
including I-9 forms, shall be grounds for immediate termination, no matter when the falsification or
omission is discovered.
_________________________________ ______________________________________
Date Signature of Employee or Prospective Employee
_________________________________ ______________________________________
Date of Birth Social Security Number
_________________________________ ______________________________________
Current Driver’s License Number Commercial Driver’s License Type & Number
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signature
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CIVIL SERVICE TESTING
This notice is to inform all prospective City of Cleveland employees of the Civil Service
testing requirement.
CIVIL SERVICE TESTING
If you have been hired by the City of Cleveland from a Civil Service list, your position
status is “regular.” If not, your status is “temporary” and you are subject to testing
through the Civil Service Commission. The Commission conducts examinations to
determine your qualifications for the position for which you have been hired. If you do
not pass the test or score sufficiently high enough to be appointed “regular,” your
employment with the City of Cleveland may be terminated.
By signing below, I acknowledge the implications Civil Service testing may have on my
future employment with the City of Cleveland.
_____________________________________ _____________________________________
Applicant’s Signature Date
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signature
click to edit
CITY OF CLEVELAND
DEPARTMENT OF HUMAN RESOURCES
EQUAL EMPLOYMENT OPPORTUNITY
As an equal employment opportunity employer, the City of Cleveland adheres to all federal, state and local
laws, rules and regulations as they pertain to equal employment opportunity and affirmative action. The
information requested below will assist us in analyzing our affirmative action efforts. We ask that you complete
the information below on a VOLUNTARY basis. Any inclusions or exclusions will NOT affect any application or
employment decision. The data secured will be used for statistical purposes only and will be maintained in a
separate confidential file.
(PLEASE PRINT) DATE
__________________________
Month Day Year
NAME
_______________________________________________ __________________________
Last First M.I. Social Security Number
ADDRESS
_______________________________________________________________________
POSITION APPLYING FOR
_________________________________________________________
HOW DID YOU LEARN OF THIS OPENING?
___________________________________________
CHECK ONE: Male Female
CHECK THE BOX OF THE RACIAL/ETHNIC CATEGORY TO WHICH YOU IDENTIFY:
White American Indian/Alaskan Native African American
Asian/Pacific Islander Hispanic Other
CHECK IF ANY OF THE FOLLOWING ARE APPLICABLE:
Vietnam Era Veteran Disabled Veteran Disabled Individual
BIRTH DATE
___________________________
Month Day Year
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Completed 12 February 2021

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