Employment Application Form

Date

MonthDayYear
Date
Name*

First NameLast Name
Birth Date

MonthDayYear
Gender

FemaleMale
Phone Number*
Type a question
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How were you referred to us?*

Walk-InReferralMercer County Head StartFacebookHometown OpportunitiesOhio Means JobsOther (Please specify)
College Attended - Degree*
College Attended - Degree*
High School Attended - Diploma Year*
Which position are you interested in? You can choose more than 1 *
List skills that qualify you for this position *
When will you be available to begin work? *
Please list your previous employment. Start with your most recent first. Provide Dates, Employer, Address, Phone #, and Position *
Were/Are you a member of or have you received benefits from School Employment Retirement System of Ohio?*

YesNo
Were/Are you a member of or have you received benefits from State Teachers Retirement System of Ohio?*

YesNo
Were/Are you a member of or have you received benefits from Ohio Public Employees Retirement System of Ohio?*

YesNo
Were/Are you a member of or have you received benefits from Ohio Police & Fire Pension Fund?*

YesNo
Were/Are you a member of or have you received benefits from Ohio State Highway Patrol Retirement System?*

YesNo
Were/Are you a member of or have you received benefits from Cincinnati Retirement System?*

YesNo
If you answered yes to any of the above questions please indicate the benefits received*

NoneServiceDisabilitySurvivor
Resume *

Cancelof
Motivation letter*
References *

Please provide 3 refererences
Reference
Reference
Reference
It is understood and agreed that Celina City Schools Board of Education may contact former employer(s) for verification of my employment history. Enter name for acknowledgement *
I understand that if I am employed prior to receipt of the BCI/FBI background reports and verification of my work experience, my continued employment will be conditioned on: 1). satisfactory work experience as verified by contacts with former employers; and 2). receipt of a report demonstrating that I am in compliance with the Board of Education rules and regulations regarding applicant / employee criminal records and disclosure of criminal convictions. Entering name below indicates agreeance to statement and electronic signature*
I promise that the information contained in this application and in my resume' is true and complete, and I understand if it is not, I may be eliminated from consideration for this job. If, after being hired, falsehoods or omissions are discovered in my application or resume', I understand that my employment may be terminated. By entering my signature, I agree to the conditions listed on this application and will if employed, tender my resignation of employment should I fail to fulfill these conditions. Enter name and date below.*

Should be Empty:

References *