Job Form - Trotwood, Ohio

AN EQUAL OPPORTUNITY EMPLOYER

The city of Trotwood complies with Equal Employment Opportunity (EEO) laws and regulations. Furthermore, the City of Trotwood considers qualified applicants for positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or military/veteran status, genetic information, or sexual orientation.

PLEASE COMPLETE ALL SECTIONS AND EACH QUESTION COMPLETELY AND ACCURATELY

This employment application is to be used for all internal, external, and seasonal or temporary job postings. We encourage you to provide a resume and cover letter in addition to this application. If you require special accommodations to participate in the application or selection process due to disability, please contact Human Resources at (937) 854-7223 or 854-7224.
Applications are kept on file for at least one year.
A separate application must be submitted for each position for which you are applying.
Applications must specifically reflect all requirements for the position, including experience and/or required courses of study. Please answer all questions accurately and completely.
By signing this application, you are affirming that all information you provide is accurate and complete.
Falsifying information may be grounds for disqualification and/or termination, if employed in the future.

Position Applying for:*

Date*

How did you hear about us?*

Shift Available:*

EDUCATION

High School*

Address*

From*

To*

Did you graduate?*

Yes

No

Diploma*

College

Address

From

To

Did you graduate?

Yes

No

Diploma

Other

Address

From

To

Did you graduate?

Yes

No

Diploma

MILITARY SERVICE

Branch

From

To

Are you subject to a Reserve obligation?

Yes

No

Rank at Discharge

EMPLOYMENT HISTORY

Company*

Phone*

Address*

Supervisor*

Job Title*

Responsibilities*

Starting Salary*

Ending Salary*

From*

To*

Reason for Leaving*

May we contact your previous supervisor for a reference?*

Yes

No

Company

Phone

Address

Supervisor

Job Title

Responsibilities

Starting Salary

Ending Salary

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Company

Phone

Address

Supervisor

Job Title

Responsibilities

Starting Salary

Ending Salary

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

OTHER QUALIFICATIONS/SPECIALIZED TRAINING/SKILLS

List any additional information covering your qualifications including any licenses or professional certificates that you hold which are applicable for this position such as typing skills, Office Equipment, Computer Software, fluency in languages other than English, and any heavy equipment/tool skills:

Other Qualifications/Specialized Training/Skills

PROFESSIONAL REFERENCES

Please list three professional references (not related to you).

Name*

First Last

Relationship*

Company*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Name*

First Last

Relationship*

Company*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Name*

First Last

Relationship*

Company*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

APPLICANT’S STATEMENTS

Statement Agreement*

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed one (1) year. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that any employment relationship with the City of Trotwood is of an “at will” nature, and means that I (as an employee if hired) may resign at any time and the Employer may discharge me with or without cause. It is further understood that this “at-will” employment relationship may not be changed by any written document or by conduct unless an authorized executive of this organization specifically acknowledges such change in writing. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate discharge. I also understand that I am required to abide by all rules and regulations of the employer.

I hereby acknowledge that I, voluntarily and of my own free will, have applied for employment with the City of Trotwood with the understanding that the City may use a variety of screening procedures to evaluate my qualifications and suitability for appointment. I have been advised that these screening procedures might include, but are not limited to interviews, criminal record checks, consumer credit reports, driving record checks, polygraph examinations, written testing, reference checks, background investigations, drug/alcohol testing, and other physical and mental assessments used to evaluate whether I am capable of performing the requirements of the position for which I am applying. However, no screening procedures will be implemented to compile or assess my genetic information or used for any discriminatory purpose.

I agree

Applicant’s Waiver & Authorization to Release Information*

As an applicant for employment with the City of Trotwood, I understand and agree that the City of Trotwood may make a thorough investigation of my past employment, education, credit history, criminal record, driving record and other activities related to the selection process.

I hereby release the City of Trotwood, its employees, agents and representatives and all others from any liability or damages which may result from the exchange of the information requested.

I also authorize and request all persons to whom this request is presented, having information relating to or concerning me, to furnish such information to a duly appointed representative of the City of Trotwood.

I also release persons, agents, representatives and others providing such information from any damages or liability which may result in the provision of requested information.

I am aware that this information may be of a personal nature and may otherwise be protected from disclosure by my constitutional, statutory, or common law privileges. I hereby expressly waive all privileges, which may attach to such communication or disclosure and release all persons, firms, and corporations from all claims, of any nature, as a result of said communications or disclosure.

Information to be disclosed may include:

Past/Present Employment Information
Educational Background

Criminal Record
Credit History

Driving Record
Drug Screen

These records will be maintained on file in the Human Resources Department.

This signed release will expire in conjunction with applicable eligibility lists for employment or 12 months from date of signature, whichever is greater. Eligibility lists may be extended beyond 12 months if approved by the Trotwood Civil Service Commission.

I agree

AUTHORIZATION TO OBTAIN CONSUMER CREDIT REPORT(S) PURSUANT TO 15U.S.C. 1681 (b) (a) (b) (2).

I hereby authorize the release of a consumer report for employment purposes to the City of Trotwood. I understand that inquiry may include, but is not limited to: my credit history, criminal arrest and conviction history, motor vehicle records, and credit check (with no impact to credit scores).

A photocopy or fax copy of this authorization shall be effective as the original. This authorization will remain in force until I specifically revoke it in writing. This authorization is given pursuant to the Fair Credit Reporting Act, 15 U.S.C. 1681.

I agree

Name of Authorizing Consumer*

First Last

Date of Birth*

Social Security Number*

ADDITIONAL DOCUMENTS

Attach Any Additional Documents or Explanations Requested Here

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HUMAN RESOURCES LINKS

AN EQUAL OPPORTUNITY EMPLOYER

PLEASE COMPLETE ALL SECTIONS AND EACH QUESTION COMPLETELY AND ACCURATELY

APPLICANT INFORMATION

PLEASE ANSWER THE FOLLOWING QUESTIONS IF THE POSITION YOU ARE APPLYING FOR REQUIRES DRIVING:

EDUCATION

MILITARY SERVICE

EMPLOYMENT HISTORY

OTHER QUALIFICATIONS/SPECIALIZED TRAINING/SKILLS

PROFESSIONAL REFERENCES

APPLICANT’S STATEMENTS

EQUAL EMPLOYMENT OPPORTUNITY (EEO) INFORMATION

ADDITIONAL DOCUMENTS

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