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					Whitehall Civil Service Commission 390 South Yearling Road Whitehall, Ohio 43213 614-338-3101 civilservice@whitehallpolice.com

Employment Application

This application for employment must be completed, signed, and dated in order for you to receive employment consideration with the City of Whitehall, Ohio. Incomplete or missing information could result in the rejection of this application. Once submitted, applications become the property of the Civil Service Commission and are subject to all applicable public records laws. THE CITY OF WHITEHALL IS AN EQUAL OPPORTUNITY EMPLOYER. Job Title for which you are applying: Application Deadline:

Personal Information
Social Security Number: Name:
(Last) (First) (Middle)

-

-

Address:
(Street and/or P.O. Box) (City) (State) (Zip Code)

Phone:

(

)

(

)

(

)

(Home Number)

(Work/Message Number)

(Mobile/Cell Number)

Are you at least 18 years of age? Are you a U.S. citizen? Are you legally eligible for employment in the United States? (Verification will be required.) Are you currently or have you ever been a City of Whitehall employee? In the past seven years, have you been convicted of a felony, misdemeanor, or summary offense which has not been annulled or expunged or sealed by a court? (If Yes, describe in full.)

Yes Yes Yes Yes Yes

No No No No No

You have received a written job description(s) listing the essential functions of the position(s) for which you have applied. Are you able to perform each of the essential job functions listed for each position for which you have applied? (If No, list the function(s) you are unable to perform and explain why you are unable to perform them.)

Yes

No

Were you in the U.S. Armed Forces? (If Yes, include copy of DD214) Are you requesting Veteran’s bonus points? (If Yes, include copy of DD214 verifying at least 180 consecutive days of active duty “Honorable” service. DD214 must be on file with the Commission by the last day of the test application period.) Are you interested in second or third shift work? (Requirement for dispatcher position.) Do you have any experiences, skills, or qualifications which will be of special benefit In the job for which you are applying? Please list them here.

Yes Yes Yes Yes

No No No No

For Civil Service Commission Use Only
REJECT: APPROVE:
City of Whitehall Employment Application │ Page 1

Licenses
Professional License(s):
(Number) (Number) (Number) (Number) (Type) (Type) (Type) (Type) (State) (State) (State) (State) (Expiration Date) (Expiration Date) (Expiration Date) (Expiration Date)

Education
High School: Circle highest grade completed:
Last High School Attended:
(Name) (City) (State)

1

2

3

4

5

6

7

8

9

10

11

12

GED certificate

You must submit a transcript, diploma, or GED certificate to establish that you meet the educational requirements of the position for which you are applying.

College/Technical (Post-High School) Education:
School Name City, State Course of Study Did You Graduate? List Degree or Certificate Earned

Yes Yes Yes Yes Yes Yes

No No No No No No

References
Full Name Relationship (Friend, Teacher, Business, etc.) Contact Information (Address & Telephone Number)

City of Whitehall Employment Application │ Page 2

Experience
Please list your past work experience beginning with the most recent employment. Military experience and volunteer work may be included as employment. You may submit a resume in addition to completing this section. This section must be completed fully even if you have previously applied for other City of Whitehall positions. If you need additional space, attach extra copies of this page. Position Title Employer Address (Street, City, State, Zip) Phone Key responsibilities and equipment operated: Hours per Week Employed from (Month/Year) Department Supervisor Full-time Temporary Part-time Volunteer Summer To (Month/Year)*

Reason for leaving: *For your current position title, be sure to indicate your start date and that you are “presently” employed. Position Title Employer Address (Street, City, State, Zip) Phone Key responsibilities and equipment operated: Hours per Week Employed from (Month/Year) Department Supervisor Full-time Temporary Part-time Volunteer Summer To (Month/Year)

Reason for leaving:

Position Title Employer Address (Street, City, State, Zip) Phone Key responsibilities and equipment operated: Hours per Week

Employed from (Month/Year) Department Supervisor Full-time Temporary

To (Month/Year)

Part-time Volunteer

Summer

Reason for leaving:

City of Whitehall Employment Application │ Page 3

Certification
I understand that nothing contained in this application, or in the granting of an interview, creates an offer of employment. I certify that all of the information furnished in the employment application and its addenda (including any attached additional sheets, transcripts, certificates or any other material submitted to be considered for employment, including resumes), is true and complete to the best of my knowledge. I understand that I am responsible for the correctness of this application. I realize that any misrepresentation or false information included in the application materials or provided in the interview process can lead to the withdrawal of an offer of employment or to termination from employment with the City of Whitehall, Ohio. I understand that the City of Whitehall, Ohio may investigate the information I have furnished, and I authorize any person, firm, or organization to supply any information about me concerning any past employment, military duty, convictions, or personal information to the City of Whitehall, Ohio. I hereby release any such person, firm or organization from any responsibility in disclosing such information. I consent that they may disclose such information to the Civil Service Commission and to officials of the municipal department that holds the vacancy for which I am applying and to appropriate officials for recruitment purposes. I understand that it is the policy of the City of Whitehall, Ohio to maintain a workplace free of illegal drugs and the misuse of alcohol, and that they will not knowingly hire anyone who uses illegal drugs. I also understand that any offer of employment made to me by the City of Whitehall, Ohio is conditional upon the results of a drug test being acceptable to the City. I accept that, if I am hired, the City of Whitehall reserves its right to test its employees for drug and alcohol use in accordance with City of Whitehall policies regarding such tests. Signature: Date:

Notes To Applicants
SPECIAL ACCOMMODATIONS: Requests for accommodations based upon permanent disabilities must be made by the time this application is submitted. If you would like to request a special accommodation or have questions regarding this process, please call the Commission offices at (614) 338-3101. BACKGROUND INVESTIGATION: When there is a position vacancy, a background investigation, including fingerprinting, will be conducted on those applicants who are certified for employment consideration. The investigation will include but not be limited to an applicant’s work history, police records and educational background. EMPLOYMENT VERIFICATION: At time of hire, employees must submit original documentation to prove identity and employment eligibility in compliance with the Immigration Reform and Control Act of 1986. IF YOU CHANGE YOUR NAME OR ADDRESS at any point in the selection processing or during the life of the eligible list, YOU MUST NOTIFY THE CIVIL SERVICE COMMISSION IN WRITING OF THE CHANGE. Failure to notify the Commission may result in disqualification from the selection process.

City of Whitehall Employment Application │ Page 4


				
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