DELAWARE COUNTY ONLINE EMPLOYMENT APPLICATION
(Please note that applications are only accepted for currently posted positions)
AN AFFIRMATIVE ACTION / EQUAL OPPORTUNITY EMPLOYER
Are You Interested In:

Full Time Work
Part Time Work 
Temporary Work
Summer Work

YES
YES
YES
YES		 NO
NO
NO
NO
Position Applying For:
Expected Salary:
$
;

PERSONAL INFORMATION:

First Name:
Middle Name:
Last Name:
Address:  
Street:
City:
State: Zip Code:
Phone:  
Home:
Business:
;

EDUCATION:

 Do you have a High School Diploma or G.E.D. Certificate?
Yes         No
If No, indicate highest grade completed.
1 | 2 | 3 | 4 | 5 | 6
7 |8 | 9 | 10 | 11 | 12
NAME AND ADDRESS OF SCHOOL,VOC. SCHOOL OR COLLEGE
TITLE OF COURSES TAKEN OR MAJOR
DID YOU GRADUATE? (CHECK IF YES)
CERTIFICATES, DEGREES, ETC. (IF YOU ATTENDED UNDER ANOTHER NAME, PLEASE INDICATE)
Please provide a college transcript for positions requiring an Associates, Bachelors or Masters degree.

PROFESSIONAL LICENSE OR CERTIFICATE OR OTHER CREDENTIAL,
IF REQUIRED FOR THIS POSITION

DESCRIPTION NUMBER ISSUED BY:
EXPIRATION DATE:  
Please list below the specific course work areas relevant to the position for which you are applying. Also, indicate the number of courses you have successfully completed in each area.
Typing Speed wpm Data Entry Speed kpm
Computer Knowledge Hardware and Software Programs:
In the area below, please describe briefly any additional training, information or special qualifications you have for the position requested. Include special courses/seminars attended, machines or equipment you operate, hobbies which have taught you qualifying skills, etc.
A

EXPERIENCE:
In the areas below, please fill out past work experience beginning with the most recent employment. If the title and duties changed materially in the course of your service in any one organization, indicate such changes as separate employment. Verifiable voluntary work may also be included as employment. NOTE: A resume may not be used as a substitute for completing this information.
PRESENT OR MOST RECENT JOB:
Employer's name and address:
Length of Employment
From: mo. yr.
To: mo. yr.
Reason for leaving:
Position Title:
Salary:
Beginning 		Ending
Duties Performed:
NEXT MOST RECENT JOB:
Employer's name and address:
Length of Employment
From: mo. yr.
To: mo. yr.
Reason for leaving:
Position Title:
Salary:
Beginning 		Ending
Duties Performed:
NEXT MOST RECENT JOB:
Employer's name and address:
Length of Employment
From: mo. yr.
To: mo. yr.
Reason for leaving:
Position Title:
Salary:
Beginning 		Ending
Duties Performed:
NEXT MOST RECENT JOB:
Employer's name and address:
Length of Employment
From: mo. yr.
To: mo. yr.
Reason for leaving:
Position Title:
Salary:
Beginning 		Ending
Duties Performed:
NEXT MOST RECENT JOB:
Employer's name and address:
Length of Employment
From: mo. yr.
To: mo. yr.
Reason for leaving:
Position Title:
Salary:
Beginning 		Ending
Duties Performed:
If the position for which you are applying includes driving, have you received any vehicle citations for moving violations within the last 5 years? (A "YES" answer to this question is not an automatic bar to employment. Each case is considered individually.) If yes, please explain fully in the space provided below.
 Yes    No
Do you claim veterans service preference? (If yes, you will be required to provide a copy of your DD214 Form. If you claim disability preference, you will be required to provide a copy of your Veterans Administration 802 Form that is less than 6 months old.
Yes    No
Have you ever been convicted of a felony or misdemeanor or been on parole or probation? List all convictions after your 18'th birthday. (A "YES" answer to this question is not an automatic bar to employment. Each case is considered individually.) If yes please explain in the space provided below.
Yes    No
Explanation:
A

REFERENCES:

 Please list the names and addresses of three professional references, other than a relative, whom we may contact.
NAME:   ADDRESS:
CITY:  STATE:  ZIP CODE:
 PHONE:
NAME:   ADDRESS:
CITY:  STATE:  ZIP CODE:
 PHONE:
NAME:   ADDRESS:
CITY:  STATE:  ZIP CODE:
 PHONE:

MISCELLANEOUS:

 The following information will be used only if it is directly relate to the position for which you are applying.
1. Do you have an Ohio Drivers License? Yes    No
License #  Class  Expiration Date
Answer only if you answered "No" to question 1.
Are you willing and able to secure an Ohio Drivers License? Yes  No
2. Do you have a Commercial Drivers License (CDL)? Yes   No
Answer only if you answered "No" to question 2.
Are you willing and able to secure a Commercial Drivers License (CDL)? Yes    No
3. If necessary, can you supply your own transportation for work use? Yes   No
4. Have you previously worked in public employment in Ohio? (i.e.: Ohio Public Employees Retirement System (OPERS), State Teachers Retirement Systems (STRS), School Employees Retirement System (SERS), Ohio Police and Fire Pension Fund (OP&F), State Highway Patrol Retirement System (HPRS), or Cincinnati Retirement System (CRS) Yes    No If yes, which one?
5. Can you perform the job related requirements of the specific job for which you are applying?
Yes   No
If you answered "Yes" to questions 4, or "No" to question 5, please explain fully below, indicating by number the question you are responding to.

Please use this space to answer or clarify any previously asked questions as needed. Please Identify which question your remarks apply to.

a

CERTIFICATE OF APPLICANT:

Read Carefully Before Submitting.
I hereby certify that all statements made in this application are true and I authorize investigation of all matters contained in this application. I understand and agree any misstatement or omission of fact on this application will cause forfeiture on my part of all rights of employment with Delaware County. I further agree to be fingerprinted, and to furnish such proof of citizenship as may be directed. I also understand and agree that all applicants conditionally selected for this position may be asked to submit a urinalysis test for illegal drug use (if required), and to a complete medical examination prior to appointments. An offer of employment shall be rescinded for an applicant with a positive urinalysis test and/or who failed a complete medical examination.
a