Union County, Ohio - Union County Employment Application

*Position Applying For

*Last Name

*First Name

*Middle Name

*Primary Telephone Number

Other Telephone Number

Email Address

*Are you legally eligible to work in the United States of America?

Yes

*Are you currently or have you ever been employed by Union County?

Yes

If yes, what office/department?

*Do you have any relatives employed by Union County?

Yes

If yes, please list name, relationship, and office/department:

*Have you ever been involuntarily terminated or asked to resign from employment?

Yes

If yes, please explain:

*Desired start date

*Desired Salary or Hourly Rate:

*Are you currently employed?

Yes

If employed, may we contact your current employer?

Yes

If we cannot contact your present employer, please explain:

Education: List the following information.

*Highest level of education attained.

High School

GED

College

Graduate School

Other

*Name of Institution and Address

Did you graduate?

Yes

*Degree earned or course of study

Job Specific Certifications or License

Title

Issued by:

Date Issued:

Expiration Date:

Drivers License

*Do you possess a valid drivers license?

Yes

State of Issuance

License #

License Class (A, B, C)

Employment Information: Please indicate your work experience, beginning with the most recent employment, and be specific in your description of job duties. Include all relevant work experience, volunteer work and military service, if applicable. Attach additional sheets if necessary or resume.

Name of Employer

Address of Employer

Supervisors Name and Title

Supervisors Phone Number

Start Date

End Date

Job Title

Salary

Reason for Leaving

Job Duties

Name of Employer

Address of Employer

Supervisors Name and Title

Supervisors Phone Number

Start Date

End Date

Job Title

Salary

Reason for Leaving

Job Duties

Name of Employer

Address of Employer

Supervisors Name and Title

Supervisors Phone Number

Start Date

End Date

Job Title

Salary

Reason for Leaving

Job Duties

Professional References: Please indicate three (3) persons, not related to you, who can be contacted regarding your work or academic performance.

Name

Title

Phone Number

Name

Title

Phone Number

Name

Title

Phone Number

Certification of Application: By signing this application, I hereby certify that every statement I have made in this application is true and complete to the best of my knowledge. I understand that any false or incomplete answer may be grounds for not employing me or for dismissing me after I begin work. I understand that I will have to produce documentation verifying identity and employment eligibility in the United States. I understand that I may be required to verify any and all information given on this application. I understand that this completed application is the property of the Union County and will not be returned. I understand that my application is subject to disclosure pursuant to the Ohio Public Records Act. I understand that Union County may contact prior employers and other references. I understand that I must notify Union County of any changes in my name, address, phone number, or email address. I understand that communications with Union County may be sent via email. I voluntarily and knowingly authorize Union County to verify the information contained in my employment application. I authorize any third party organization to perform a consumer report and background investigation. I also authorize and consent any employers, schools or persons listed on this application (or accompanying resume) to provide information regarding my employment, qualifications and character to Union County (including but not limited to performance evaluation and reports, job descriptions, disciplinary reports, letters of reprimand, and opinions regarding my suitability for employment). I understand that I may be required to take a drug test, as a condition of employment or at any time during employment. I voluntarily and knowingly, fully release and discharge, absolve, indemnify and hold harmless you, your agents and any former employer, person, firm, corporation, school or government agency, its officers, employees and agents from any and all claims, liability, demands, causes of action, damages, or costs, including attorney's fees, present or future, whether known or unknown, anticipated or unanticipated, arising from or incident to the disclosure or release of any such information to you, your agents, or consumer reporting agency. READ CAREFULLY BEFORE SIGNING: I agree that any claim or lawsuit relating to my service with Union County must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary. I have read and understand the contents of this employment application and am fully able and competent to complete it.

*Signature

*Date

Union County Record-Maintenance Form The Federal Guidelines on Employee Selection (1978) require employers to maintain and have available for inspection, records or other information which will disclose the impact which the employer's test and other selection procedures have upon employment opportunities of person by identifiable race, gender, and ethnic group. Compliance with this mandate requires that each applicant be requested to complete the following questions relating to gender and race. Your responses to the questions relating to gender and race are voluntary. Information concerning your knowledge that a position was available will assist us in our recruitment efforts. Thank you for your cooperation.

*Position Applied for:

*Gender (Please check one)

Male

Female

Prefer not to answer

*Race (Please check the category that applies to you)

White/Caucasian

Black/African American

American Indian (Including Alaskan Natives)

Asian (Including Pacific Islanders)

Hispanic (including persons of Mexican, Puerto Rican, Cuban, Central or South American origin or culture, regardless of race)

Other

Prefer not to answer

Other (Please specify)

*Are you a veteran of the armed forces?

Yes

Prefer not to answer

*How did you hear about this position?

Job Posting

Word of Mouth

Union County Website

Bulletin Board (please specify where):

Newspaper (please specify):

Internet (please specify):

Other (please specify):

Please Specify