Police Fire Service Administration
Volunteer Full-Time Part-Time Seasonal
(Last) (First) (Middle)
(Street and/or P.O. Box)
(City) (State) (Zip Code)
(Home) (Work) (Other)
Police Applicants only: Are you at least 21 years old? yes no
Are you OPOTA certified? yes no
Do you have any relatives employed by the City? yes no
If yes, who and what department do they work for? ______________________________________________
Please be advised that you may be disqualified from employment in certain positions with the City of Riverside if the
Are you at least 18 years of age?
Type of employment desired
result of the criminal background check reveals a particular criminal history.
Are you currently employed?
Have you ever been employed by the City of Riverside?
Are you legally eligible for employment in the United States?
If yes, give department and date _____________________________________________________________
Date available for work: ________/________/________
The City of Riverside is an Equal Opportunity Employer. Those applicants requiring reasonable accommodations to the
application and/or interview process should notify a representative of the Human Resources Department.
5200 Springfield Street, Suite 100, Riverside, OH 45431
Position (s) Applied For: ________________________Date of Application: ________
Telephone Number(s): ______________________________________________________________________________
If yes, may we contact your employer?
Driver's License Number: _______________________________ Class______________ State ___________