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Personal Information

First Name*
Last Name*
Address1*
City*
State*
Zip*
Phone Number*
Email Address
Type of Employment Desired*
Are you legally authorized to work in the United States?*
Are you able to work any shift?*
Are you able to work overtime if necessary?*
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Position Information

What position are you applying for?*
Desired Rate of Pay*
Have you had previous City employment?*
If employment is offered, when are you available for work?*
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Education

High School*
Address
Did you graduate?*
College
Address
Course of Study
Degree
Dates Attended
Other
Address
Course of Study
Degree
Dates Attended
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Licenses, Certifications, Registrations

Do you presently have a valid State of Ohio Driver's License?*
Do you presently have a valid State of Ohio Commercial Driver's License?*
List below any licenses, certificates, or registrations you have that relate to or are required for this position.
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Training and Other Qualifications

In the area below, briefly describe any training, skills, or special qualifications you have for the position for which you are applying. Please be sure to include any special machinery or equipment able to operate, tools, vehicles, or other job related items.
If apply for dispatching, clerical, or secretarial positions, please provide the following information: office equipment able to operate, typing speed, and software proficient in.
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Employment History

Please list current and previous employment, beginning with most recent.
Employer*
Job Title*
Employed From - To (Date)*
Address*
Phone Number*
Supervisor
Ending Salary*
Responsibilities*
Employment Status*
Reason for Leaving*
May we contact your current employer prior to employment?*
Employer
Job Title
Employed From - To (Date)
Address
Phone Number
Supervisor
Ending Salary
Responsibilities
Employment Status
Reason for Leaving
Employer
Job Title
Employed From - To (Date)
Address
Phone Number
Supervisor
Ending Salary
Responsibilities
Employment Status
Reason for Leaving
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Personal References

Please provide three references who are not related to you.
Full Name*
Occupation
Phone Number*
Full Name*
Occupation
Phone Number*
Full Name*
Occupation
Phone Number*
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Disclaimer & Signature

By signing below, you are indicating your understanding of, and consent to, the contents and conditions of the following information. If you have any questions regarding this information, contact the Personnel Office of the City of St. Marys before signing. If employed, this application becomes part of your official employment record.
I certify the information set forth in this employment application is true, accurate, and complete to the best of my knowledge. I understand and accept that any information found to be falsified or intentionally excluded, may disqualify me from further consideration or, if employed, may result in disciplinary action, including termination of my employment, whenever discovered. I authorize the employers, schools, and personal references named in this application to provide and release records of employment, academic, and other information regarding myself to the City of St. Marys.
I hereby specifically waive any right to personal privacy I might have in the above information and release the City of St. Marys and any person or agency from any liability whatsoever resulting from the release of such information. I understand employment-related documents of a public entity in Ohio are subject to inspection by members of the public under the Ohio Sunshine Law.
If employed, I understand and accept that, depending on the department that I am applying for, I may be required to work evening shifts, night shifts, weekends, and/or be on call and be required to work mandatory overtime. I further understand, if employed, I will be required to provide proof of identity and employment eligibility to work in the United States.
Applicant Signature*
Date*
Date
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Affirmative Action Data Record

Voluntary Information Form
Employees are treated during employment without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmative Action responsibilities where they apply.
The purpose of this Data Record is to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of this Data Record is optional. If you choose to volunteer the requested information please note that all Data Records are kept in a Confidential File and are not a part of your Application for Employment or personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.
First Name
Last Name
Position Applied For
Date
Referral Source
Check One
Check One of the Following
Check if any of the Following are Applicable
1. Vietnam Era Veteran
2. Disabled Veteran
3. Disabled Individual
Birthdate:

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1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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