Fillable Form 2.: CITY OF SPRINGFIELD, OHIO (City Of Springfield, Ohio)

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Form 2.: CITY OF SPRINGFIELD, OHIO (City Of Springfield, Ohio)

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CITY OF SPRINGFIELD, OHIO
EMPLOYMENT APPLICATION
(Please Print)
SECTION I - PERSONAL INFORMATION
Social Security #
Last First Middle
4. Address:
Number & Street
Telephone: Cell #
Home #
City State
Zip
Approved
Disapproved
6. Are you 18 or older?
Yes No
Yes No
7. If hired, can you give written evidence of your right to work in this country?
8. What is your reason for interest in this job?
9. List any reason why you would be unable to perform the essential functions, or fundamental job duties, of
this position:
Yes No
Dept:
10. Do you now or have you ever worked for the City of Springfield?
*If yes, when and for what department? From: To:
11. Do you have a valid Driver's License or Commercial Driver's License?
What State? License Class?
Please List Endorsements:
Date:
Time:
Received by:
Yes No
1. Position applying for:
2.
MILITARY CREDIT CLAIM
If you claim military service credit, check the box to the right. A copy
of the Honorable Discharge or DD-214, specifying an Honorable
Discharge, must be submitted with this application.
3. Name
MILITARY
FOR OFFICE USE ONLY
Yes
5. Email Address:
SECTION II - EDUCATION AND TRAINING
Place "X" in column for highest grade completed Name and Location of High School
1 2 3 4 5 6 7 8 9 10 11 12
Other
Schools
Dates
From To
Name of
School
City /
State
Major Minor
Name of
Degree
College or
University
Graduate
School
Vocational or
Business
School
If you have received TRAINING in an area which you feel is relevant to the position for which you are applying, please
submit the following information (do not include training gained as part of your education as described above):
Type of Training Organization Length of Training Subject Covered
Length of Employment Title of Position Held Name & Address of Employer
From: Mo. ______ Yr.______ _______________________ ________________________________
To : Mo. ______ Yr.______ _______________________ ________________________________
Full-time
Duties performed: _______________________________________________________
Part-time _______________________________________________________________________
_______________________________________________________________________
Reason for leaving:
_____________________________
_______________________________________________________________________
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Length of Employment Title of Position Held Name & Address of Employer
From: Mo. ______ Yr.______ _______________________ ________________________________
To : Mo. ______ Yr.______ _______________________ ________________________________
Full-time Duties performed: _______________________________________________________
Part-time _______________________________________________________________________
_______________________________________________________________________
Reason for leaving:
_____________________________
_______________________________________________________________________
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Length of Employment Title of Position Held Name & Address of Employer
From: Mo. ______ Yr.______ _______________________ ________________________________
To : Mo. ______ Yr.______ _______________________ ________________________________
Full-time Duties performed: _______________________________________________________
Part-time _______________________________________________________________________
_______________________________________________________________________
Reason for leaving:
_____________________________
_______________________________________________________________________
SECTION III - WORK EXPERIENCE
RESUME ATTACHED - You must still complete Work Experience Section above.
**Please list additional work experience on a separate sheet.
FULLY DESCRIBE your work experience beginning with your most recent job. Include relevant military and volunteer experience.
May we contact your present employer? Yes No
✔
✔
SECTION IV - PROFESSIONAL REFERENCES (Please do not include relatives)
NAME & OCCUPATION ADDRESS PHONE NUMBER
1. _________________________________________________________________________________________________________
2. _________________________________________________________________________________________________________
3. _________________________________________________________________________________________________________
SECTION V - RELEASE
BEFORE SIGNING, PLEASE CHECK THROUGH ENTIRE APPLICATION FOR ERRORS OR OMISSIONS
I hereby certify that, to the best of my knowledge and belief, all statements made herein or attached are complete and
accurate. I understand that any false statements later disclosed will cause loss of my right to examination, certification,
appointment or retention of position and may subject me to prosecution under Ohio Revised Code Section 2921.13.
Furthermore, I hereby authorize the City of Springfield to contact prior employers, educational institutions, and
references listed above to obtain any and all information related to my past work performance, experience or education.
Signature of Applicant: ______________________________________________ Date: _____________________
THE CITY OF SPRINGFIELD IS AN EQUAL OPPORTUNITY EMPLOYER
EEO / MINORITY / FEMALE / DISABLED
CITY OF SPRINGFIELD, OHIO
EQUAL EMPLOYMENT OPPORTUNITY INFORMATION SHEET
Please submit this sheet with your employment application.
DATE:
NAME:
JOB DESIRED:
DIRECTION: The Personnel Department requests that you supply the information below in order to assist our efforts
in regard to equal employment opportunity. This information will in no way affect the processing of
your application. This information sheet will be processed separately and will be used for statistical
purposes only. It is gathered under the authority of Ohio Civil Rights Commission Rule 4112-5-04.
RACE:
White
Persons having origins in any of the original peoples of Europe, North Africa, or
the Middle East.
Black Persons having origins in any of the black racial groups.
Hispanic Persons of Mexican, Puerto Rican, Cuban, Central or South American, or other
Spanish culture or origin, regardless of race.
American
Indian:
Alaskan Native
Persons having origins in any of the original peoples of North America, and who
maintain cultural identification through tribal affiliation or community recognition.
Asian / Pacific
Islanders
Persons having origins in any of the original peoples of the Far East, Southeast
Asia, Indian Subcontinent, or the Pacific Islanders.
HOW DID YOU BECOME AWARE OF THIS POSITION? Note: Please mark all that apply.
A) Newspaper
B) Online
If yes, which newspaper?
C) Job Posting If yes, where?
D) Personal Contact If yes, give name.
E) Other Please Explain.
SEX: MALE FEMALE
If yes, which website?
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Form 2.: CITY OF SPRINGFIELD, OHIO (City Of Springfield, Ohio)

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Completed 5 August 2020

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