Current Date ... *

Department for which I am applying Administration
Building
Community Affairs
Golf
Public Works
Parks and Recreation
Police
*

Position(s) Applying For: *

First Name *

Middle Name

Last Name *

Maiden Name or Alias

Primary Phone *

Alternate Phone

Best Time to Contact You *

Email Address *

Are you 18 years of age or older? Yes No *

Are you able to provide proof of your lawful authorization to work in the United States? Yes No *

Do you have a valid Ohio Driver License? Yes No *

Has your driver license ever been revoked/suspended? Yes No *

Have you ever been convicted of a felony? Yes No *

If YES, explain

Have you ever filed an application with the City of Groveport before? Yes No *

Have you lived in Ohio less than five consecutive years? Yes No *

If YES, in what state(s) did you live?

Do any of your friends or relatives work for the City of Groveport? Yes No *

If YES, state their name and relationship to you.

Are you currently on lay-off status and subject to recall? Yes No *

I wish to work Part-time Full-time *

What is your desired hourly wage range? $__ to $___

What is your desired annual salary?

Date Available for Work ... *

Start with your present or most recent job. List all jobs (including military service) for at least the past ten years. Your qualifications will be evaluated solely on the application form, and, if applicable, any supplemental interview or questionnaire. Resumes may not be substituted for the requested information.

Does your present employer know that you are looking for new employment? Yes No

Have you ever been terminated? Yes No

Select the HIGHEST grade completed. Less than 8th grade 8th grade 9th grade 10th grade 11th grade 12th grade College Freshman College Sophomore College Junior College Senior Masters Ph.D. *

Indicate your level of computer skill for each of the following programs.

Word Minimal Experience Formal Training Paid Experience

Publisher Minimal Experience Formal Training Paid Experience

Excel Minimal Experience Formal Training Paid Experience

Power Point Minimal Experience Formal Training Paid Experience

Photoshop Minimal Experience Formal Training Paid Experience

Pagemaker Minimal Experience Formal Training Paid Experience

Please list other computer experience.

Please list any additional information you feel may be helpful to us in considering your employment. (example - specialized training skills, extra-curricular activities, hobbies, etc.)

Additional Information

I certify that answers given herein are true and I agree and understand that any false or misleading statement contained herein may cause rejection of this application or termination of employment. I authorize the City of Groveport to contact my current and past employers and personal references, and to investigate all statements contained in this application for employment. I understand that I will have to provide acceptable documentation attesting that I am a U.S. Citizen or legal immigrant eligible for work in the United States. I also understand that I will not be hired until I have successfully completed the employment process, including a criminal background investigation. The results of the criminal background investigation will be used by the City of Groveport to ascertain the eligibility, appropriateness or fitness of all applicants for work within the City of Groveport. I understand that this application is not a contract for employment. I understand that any oral or written statement to the contrary is expressly disavowed, and should not be relied upon by any prospective or existing employee. I hereby understand and acknowledge that, unless otherwise defined by applicable law, my employment with this organization is of an “at will” nature, which means that the employee may resign at any time and the employer may discharge the employee at any time 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 such change is specifically acknowledged in writing by the Administrator. I understand that I am required to abide by all rules and regulations of the employer.

I agree *

Regulations of the Equal Employment Opportunity Commission (EEOC) require employers to compile data regarding the nature and make-up of their work forces in order to further the goals of Title VII of the Civil Rights Act of 1964, as amended.  Your responses to the following questions will help the employee comply with this requirement.  Completion of this questionnaire is entirely voluntary on your part.  Should you opt to complete the questionnaire, your response will be used by the employer solely for the purposes of preparing the reports required by the EEOC.  Your response will be kept confidential, and will play no part in the employer’s evaluation of your employment performance or status, or your treatment as an employee.  The completed questionnaire will be kept separate from your personnel file.

Name

Age

Sex

Racial and Ethnic Categories White (not of Hispanic origin)
Black (not of Hispanic origin)
Hispanic
Asian or Pacific Islander
American Indian or Alaska Native