CITY OF ROSSFORD
EMPLOYMENT APPLICATION

The City of Rossford is an equal opportunity employer and does not discriminate against qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, sexual orientation, gender identity, marital status, national origin, disability, veteran status or any other status as protected by local, state or federal law.

Please complete this application legibly in ink. Please respond to all questions indicating N/A to those that do not apply.

Required fields are marked with a

PERSONAL INFORMATION
Last Name First Name Middle Name Email
Street Address City State Zip
Telephone Alternate Phone Number
POSITION INTEREST/AVAILABILITY
Position Applying For Other Position You Would Consider
Date Available to Begin Work Status Desired Salary Requirements
Regular Temporary Full Time Part Time
Hours Available: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Available From
Available To
GENERAL INFORMATION
Have you ever been employed by the City of Rossford? Yes No
If yes, please list dates If employed under a different name, please note name
Are you over the age of 18 years? Yes No. If under 18, list date of birth
(If under 18, you will be required to provide a work certificate and proof of parental consent)
Are you legally eligible for employment in the United States? Yes No
(If employed, you will be required to provide documentation to verify eligibility)
Have you ever been terminated or have you resigned in lieu of being terminated? Yes No
If yes, please explain
Do you have any relatives working for the City of Rossford? Yes No
If so, please specific full name of employee
How did you hear about this position?
Advertisement (please note where)
Website
Employee (please note name)
School (please specify)
Other (please specify)
EDUCATION AND TRAINING
Type of School Name of School/Address Graduated Type of Degree, Diploma,
Certificate and Major/Minor
Area of Study
Name if Different
Yes No
High School or GED
Vocational/Technical or Two Year College
College or University
Graduate School
Other
LICENSURE, CERTIFICATION OR REGISTRATIONS
Licensure, Certification or Registration Held Issued By Number Date Issued Date Expires
OFFICE SKILLS
Typing wpm Data Entry wpm
Proficient in Usage of Software (check all that apply) Proficient in Usage of Office Equipment (check all that apply)
Word Excel Facsimile Switchboard
Access PowerPoint Copy Machine Personal Computer
Outlook Other Telephone Systems Other
EMPLOYMENT HISTORY - Please begin with current or most recent employer. Do not exclude any employment. Explain periods of unemployment and include U.S. Military Service.
Company Name Date From Date To Job Title
Address Hourly Rate or Salary Hours per Week Description of Job Duties
Telephone Number Supervisor Name and Title
Reason for Leaving
May we contact your current employer? Yes No

Company Name Date From Date To Job Title
Address Hourly Rate or Salary Description of Job Duties
Telephone Number Supervisor Name and Title
Reason for Leaving
May we contact your current employer? Yes No

Company Name Date From Date To Job Title
Address Hourly Rate or Salary Description of Job Duties
Telephone Number Supervisor Name and Title
Reason for Leaving
May we contact your current employer? Yes No
PROFESSIONAL REFERENCES - Please list three individuals who are not related to you or supervisors listed above.
Name Address Telephone Number Relationship to You Years Known

Please Read Carefully Before Submitting - Applicant's Certification and Agreement

I hereby certify that the information and facts set forth in this application are true, complete and accurate to the best of my knowledge. I understand that any falsifications, misrepresentations or omissions of any facts in this application or other documents submitted for consideration of employment will be cause for denial of employment or immediate termination of employment, if employed regardless of the timing or circumstances of discovery.

I understand that if I am hired this application becomes a part of my official employment record.

I authorize the City of Rossford to verify the accuracy of any information provided or known. I hereby authorize any and all schools, employers, references, regulatory boards, courts and any others who have information about me to provide such information to the City of Rossford and/or any of its employees, representatives, agents or vendors. I release all parties involved in this process from any liability for any and all damage that may result from providing such information.

I understand that if offered a position, I may be required to submit to a pre-employment drug screening and criminal background check as a condition of employment. I further understand that I may be required to complete a pre-employment physical exam depending upon the position offered. I understand that receipt of unsatisfactory results from, failure to complete as required or any attempt to affect the results of these, will result in the immediate withdrawal of any offer of employment or the termination of employment, if already employed.

I understand that submission of an application does not guarantee employment. I further understand that should an offer of employment be made by the City of Rossford, such offer whether or not stated is for employment at will, and that if I accept such offer, my employment may be terminated by either the City of Rossford or myself at any time, with our without cause or notice. I understand that none of the documents, policies, procedures, actions, or statements of the City of Rossford or its employees or representatives used during the hiring process or during my employment may be deemed to be a contract for employment, either actual or implied. I understand that no employee or representative, other than the City Administrator/City Council of the City of Rossford, has the authority to enter into any agreement contrary to the above and that any such agreement if made shall not be binding unless it is set out in writing signed by the City Administrator/City Council.

I agree that any claim or lawsuit relating to my service with the City of Rossford 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.

In consideration of employment, if offered, I agree to abide by and adhere fully to all rules, regulations, policies and procedures of the City of Rossford at all times. I further understand that the City of Rossford's rules, regulations, policies and procedures may be changed at any time, with or without notice.

Enter Today's Date To Signify Agreement: