Fillable Employment Application (Please print clearly) (Revize)

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Employment Application (Please print clearly) (Revize)

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The Employment Application (Please print clearly) (Revize) form is 3 pages long and contains:

  • 2 signatures
  • 52 check-boxes
  • 117 other fields

Country of origin: US
File type: PDF

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15 S. College Ave.
Oxford, OH 45056
513.524.5200
Fax: 513.523.7298
Employment Application
(Please print clearly)
Applicant Information
Full Name: Today’s Date:
Last First M.I.
Department applying for:
Present
Address:
Street Address E-Mail Address
City State ZIP Code
Home Phone:
( )
Daytime Phone: ( ) Mobile: ( )
Permanent
Address:
Street Address
City State ZIP Code
Phone:
( )
E-mail Address:
Are you a citizen of the United States?
YES NO
If no, are you authorized to work in the U.S.?
YES NO
Have you previously been employed by the City?
YES NO
If yes, when?
Do you have a valid driver’s license?
YES NO
If no, is there any reason that would prevent you
from obtaining one?
If your application is considered favorably, on what date will
you be able to start work?
If considering part-time work, please specify availability.
Education
NAME & LOCATION OF SCHOOL GRADUATED MAJOR
DIPLOMA/
DEGREE OR
CREDIT HRS
High School
YES NO
College/Univ
YES NO
College/Univ
YES NO
College/Univ
YES NO
Other Training/Education:
Military Service
Branch: From: To:
Rank at Discharge: Type of Discharge:
If other than honorable, explain:
YES NO
If yes, please explain:
Police
Fire
Service
Parks / Rec
City Admin.
Community Dev. Finance
Position applying for (please specify): _____________________
How did you learn about job opening:_______________________
Resume Attached: Yes No Previous Employment m
ust be completed even if resume is attached.
Previous Employment
Company: Phone:
( )
Address: Supervisor:
Job Title: Starting Salary:
$
Ending Salary:
$
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference?
YES NO
Company: Phone:
( )
Address: Supervisor:
Job Title: Starting Salary:
$
Ending Salary:
$
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference?
YES NO
Company: Phone:
( )
Address: Supervisor:
Job Title: Starting Salary:
$
Ending Salary:
$
Responsibilities:
From: To: Reason for Leaving:
May we contact your previous supervisor for a reference?
YES NO
Additional Experience
Are there any other experiences, skills, or qualifications which you feel would especially qualify you for work with the City of Oxford?
References
(
Do not list relatives or former em
p
lo
y
ers
)
Full Name Home Address Phone Business
Years
Known
( )
( )
( )
( )
( )
( )
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may
result in me being denied employment or later released as an employee. I authorize the City to make an investigation of
any facts set forth in this application.
Signature: Date:
It is our policy to comply with all applicable state and federal laws prohibiting discrimination in
employment based on race, age, color, sex, religion, national origin, or other protected classification.
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signature
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Voluntary Applicant Data Form
This information is used to determine if our recruitment efforts are reaching all segments of the population, consistent with the Federal
equal employment opportunity laws. Completion of this form is
voluntary.
Name (Last, First, Middle Initial)
Position Applied For:
Address
Gender
Female
Birth Date Home Phone Cell Phone
Veteran
Yes
No
Ethnic Origin (Please Check One)
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or
origin, regardless or race.
Not Hispanic or Latino
American Indian or Alaska Native: A person having origins in any of the original peoples of North or South America
(including Central America), and who maintains tribal affiliation or community attachment.
Asian: A person having origins in any or the original peoples of the Far East, Southeast Asia, or the Indian subcontinent,
including, for example Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, Thailand, Vietnam or the Philippine
Islands.
Black or African American: A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam,
Samoa, or other Pacific Island.
White: A person having origins in any of the original peoples of Europe, the Middle East or North Africa.
How did you find out about this job?
01 – Employee Referral
03
- Professional Publication
05 – Newspaper
07 - Human Resources Office
02
- Job Fair (specify): ______________
04 - Internet ad
06 - Social Media (specify)_____________
Other(specify): ______________________
SIGNATURE OF APPLICANT ________________________________ DATE _______________
Two or More Races: Not hispanic or latino
Email
Male
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Employment Application (Please print clearly) (Revize)

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Completed 31 March 2022

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