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)
yes no
Police Applicants only: Are you at least 21 years old? yes no
Are you OPOTA certified? yes no
yes no
Do you have any relatives employed by the City? yes no
yes no
yes no
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?
Address: ________________________________________________________________________________________
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: ________/________/________
Employment Application
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
www.riverside.oh.us
________________________________________________________________________________________
Position (s) Applied For: ________________________Date of Application: ________
Personal Information
Name: __________________________________________________________________________________________
PLEASE PRINT
Telephone Number(s): ______________________________________________________________________________
If yes, may we contact your employer?
Driver's License Number: _______________________________ Class______________ State ___________
Telephone Number
Please describe the duties you have performed which demonstrate the knowledge, skills and abilitiies to perform the duties of which you are applying.
Address (Street, City, State, Zip)
Duties and Responsibilities:
Reason for leaving:
Reason for leaving:
Employer
Ending Salary
Job Title
Job Title
Supervisor
Dates Employed (MM/YYYY)
From
To
Supervisor
Duties and Responsibilities:
Starting Salary
Address (Street, City, State, Zip)
Starting Salary
Ending Salary
Telephone Number
Telephone Number
Dates Employed (MM/YYYY)
From
To
Starting Salary
Ending Salary
From
To
Employer
Address (Street, City, State, Zip)
Supervisor
Job Title
Duties and Responsibilities:
Reason for leaving:
Start with your current or most recent job. Attach additional pages if necessary. All sections must be completed.
Employment Experience (professional resume can substitute the following information)
Dates Employed (MM/YYYY)
Employer
yes no
EMS:
FIRE:
Heavy Equipment _________________________________________
CDL
Typing _________ wpm
Ohio Peace Officer Certified
Do you have a high school diploma, GED Certificate or equivalent?
Education
Level: _________________
Certification # _______________
City, State
Course of Study
Years
Completed
Computer Software ________________________________________
Specialized Skills: Check any of the following that you are proficient in
Degree or Certificate
Earned
Training and Other Qualifications
Office Equipment _________________________________________
Please list any training which you have received which may be relevant to the city position for which you are applying.
Other (please specify military,
business, trade)
City, State
Years
Completed
Degree
Course of Study
Years
Completed
Level: _________________
Certification # _______________
Summarize other special skills and qualifications you possess which are related to the position applied for:
Additional Information
College
City, State
Course of Study
Degree
Graduate School
(Name) (Address)
(Name) (Address)
(Name) (Address)
(Phone Number)
3. ____________________________________________________________________________________________
1. ____________________________________________________________________________________________
(Phone Number)
I understand and accept that if driving a motor vehicle is an essential function of any position I might obtain with the City of
Riverside, my continued employment is conditioned upon my maintaining the operator's license required for such position.
2. ____________________________________________________________________________________________
(Phone Number)
I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.
By my signature below, I certify that all answers given in this application are true and complete. I understand that if any
information in this application is found to be false or intentionally misleading or excluded, I may be ineligible for further
consideration, or if already employed, my employment may be terminated.
I understand that if I am selected for employment, my employment is conditioned upon passing a pre-employment physical
and drug test and may also, depending upon the position I am applying for, be conditioned upon passing a criminal
background check.
Signature of Applicant ________________________________________________________ Date: _______________
I understand that if I am employed, I may be required to work evening shift, night shift, weekends and/or be on-call and be
required to work mandatory overtime.
Persons not related to you
References
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome