Springfield Township Online Application

Position Applying For *

Full-time or Part-time

Full Name *

First Middle Last

Any Maiden or Alias Names Previously Used *

First Name Last Name

Address *

Street Address Line 1

Street Address Line 2

City State

Zip Country

Social Security Number *

Date Of Birth *

Drivers License # / State *

E-mail *

Phone Number *

Available start date: *

Do you have a valid driver's license? *

No Yes

Have you ever been convicted of any violation of the law? (Exclude traffic violations) A conviction will not necessarily disqualify an applicant from the position sought. *

Yes No

Have you ever had your license ever suspended or revoked in any state or military location? *

Yes No

Are you authorized to work and remain in the United States? *

Yes No

Were you ever discharged or forced to resign from any position? *

Yes No

If Yes, Explain: *

Have you ever been employed by Springfield Township Richland County, Ohio *

Yes No

Position: *

Department: *

Are you related to any Springfield Township employee? *

Yes No

Name of Employee: *

Relationship: *

Department: *

Have you served in the U.S. Armed Forces? *

Yes No

If Yes, Branch: *

Date Entered Active Duty: *

Date

Date Released Active Duty: *

Date

If Yes, Explain: *

Are you a High School Graduate? *

Yes No

High School Equivalency? *

Yes No

Are you presently attending school? *

Yes No

Type of Education *

Name of Instiution *

Field of Study *

Type of Degree *

Did you Graduate? *

Yes No

Do you have additional education to enter? *

Yes No

Additional Type of Education *

Name of Instiution *

Field of Study *

Type of Degree *

Did you Graduate? *

Yes No

Do You have Any of These Certifications *

Paramedic Advanced EMT - I EMT FF I FF II

State / ID Number *

Expiration Date *

Date

List Computer Background and Years of Experience: *

Please List Any Large Trucks Or Equipment Operated: *

Please list any Skills That Might Be Considered Beneficial For Springfield Township *

Name of Employer: *

Job Title: *

Phone Number *

Area Code Phone Number

Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Supervisor: *

Date ended *

Date

Date started *

Date

Reason for Leaving: *

Description of Duties: *

Do you have additional employers to enter? *

Yes No

Name of Employer: *

Job Title: *

Phone Number *

Area Code Phone Number

Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Supervisor: *

Date started *

Date

Date ended *

Date

Reason for Leaving: *

Description of Duties: *

Inquiry may be made of your current and former employers/schools you attended.

May we contact your present employer? *

Yes No

May we contact your former employers? *

Yes No

Full Name *

First Name Last Name

Business or Occupation *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

Email *

example@example.com

Full Name *

First Name Last Name

Business or Occupation *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

Email *

example@example.com

Full Name *

First Name Last Name

Business or Occupation *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

Email *

example@example.com

APPLICANT’S STATEMENT AND AUTHORITY TO RELEASE INFORMATION (Required for ALL Positions) I understand that this employment application and any other township documents are not contracts of employment, and any person hired may be terminated by the employer at any time for any reason during a one year probationary period. I understand that any oral or written statements to the contrary are expressly disavowed and should not be relied upon by a prospective or existing employee. I understand that Springfield Townshp may modify, change, or revoke any of its employment policies, pay practices, and benefits without my agreement. I hereby state that all answers on this application are true and understand that falsifying this information can lead to termination if hired. I UNDERSTAND THAT IN ACCORDANCE WITH TOWNSHIP POLICY, FINAL CANDIDATES ARE SUBJECT TO AN ALCOHOL / DRUG TEST AS A CONDITION OF EMPLOYMENT. I hereby authorize any and all persons, companies, or agencies to release any and all background information, of a confidential or privileged nature, including criminal history, relevant to this application and any pertinent information they may have to the hiring authorities of Springfield Township. I release all such parties from all liability of every kind as the result of furnishing the same to Springfield Township. This information is to be used to assist the township in determining my qualifications and fitness for the position I am seeking. I hereby release Springfield Township and its officers, agents and employees from any liability for the use of any and all of the foregoing information, in consideration for being reviewed for the aforesaid position.

Signature *

Clear

Date *

Date

The following information we are soliciting is strictly voluntary. This form will be kept separate and confidential from the application. Information provided on this form will not be considered in any employment decision but is for statistical purposes only.

Position Applying For *

Full Name *

First Name Last Name

Age *

Gender *

Male Female Other

How did you learn about this position?

Employment Office Township Employee School Newspaper Internet Career Fair Walk-In

Do you have any physical or mental disabilities which may limit your ability to perform essential functions of this job or which would require any special accommodations?

Yes No

If Yes, Please explain:

Date

Comments:

Signature *

Clear

Upload A Resume or Any File Applicable

Upload a File

Resume or Applicable to Springfield Fire

Please upload a current photo of your head from shoulders up.

Application for Employment For Springfield Township Fire Department

Education:

Professional License or Certificate, If Required

Skills

Employment History

Personal References

EQUAL EMPLOYMENT OPPORTUNITY QUESTIONAIRE