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Employment Application

* indicates a required field.

Position Applying For

Where did you learn about this Position

Newspaper

Website

Current Employee

Other

specifiy which newspaper, website, employee, or describe other option

Enter other…

Last Name

First Name

Middle Name

Address

City

State

ZIP code

List all previous addresses for the past three (3) years

Street, City, State and ZIP Code

Telephone Number

Email Address

Date of birth (optional)

If you are under 18 years of age, can you provide proof of your eligibility to work?

Yes

No

Have you ever been employed with us before

Yes

No

date of employment

Are you prevented from lawfully becoming employed in this Country because of Visa or Immigration Status?

Yes

No

Availability

Full Time

Part Time

May we contact your present employer?

Yes

No

Date available for work

Are you currently employed?

Yes

No

Are you currently on “lay-off” status and subject to recall?

Yes

No

Can you travel if a job requires it?

Yes

No

Education/Training

High School

Name

Course of Study

Years Completed

Diploma/Degree

Undergraduate College

Name

Course of Study

Years Completed

Diploma/Degree

Graduate Professional

Name

Course of Study

Years Completed

Diploma/Degree

Other

Name

Course of Study

Years Completed

Diploma/Degree

Describe any specialized training, skills and extra-curricular activities:

Please list below any valid certifications and/or licenses you currently hold. Please review the position’s classification specification for which you are applying for position-specific required or recommended certifications and/or licenses.

Employment History

Employer 1

Employer Name

Address

Dates Employed (from/to)

Worked Performed / Responsibilities

Job Title

Supervisor

Reason for Leaving

May we contact this employer?

Yes

No

Employer 2

Employer Name

Address

Dates Employed (from/to)

Job Title

Worked Performed / Responsibilities

Supervisor

Reason for Leaving

May we contact this employer?

Yes

No

Employer 3

Employer Name

Address

Dates Employed (from/to)

Job Title

Worked Performed / Responsibilities

Supervisor

Reason for Leaving

May we contact this employer?

Yes

No

Employer 4

Employer Name

Address

Dates Employed (from/to)

Job Title

Worked Performed / Responsibilities

Supervisor

Reason for Leaving

May we contact this employer?

Yes

No

Employer 5

Employer Name

Address

Dates Employed (from/to)

Job Title

Worked Performed / Responsibilities

Supervisor

Reason for Leaving

May we contact this employer?

Yes

No

Employer 6

Employer Name

Address

Dates Employed (from/to)

Job Title

Worked Performed / Responsibilities

Supervisor

Reason for Leaving

May we contact this employer?

Yes

No

List professional, trade, business or civic activities and offices held.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, military status or other protected status

Additional Information

Skills

Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills

Include equipment-operated skills, i.e., computer, motorized equipment. Please review the position’s classification specification for which you are applying for position-specific skills and equipment used.

State any additional information you feel may be helpful to us in considering your application

References

Reference 1

Name

Telephone Number

Address

Reference 2

Name

Telephone Number

Address

Reference 3

Name

Telephone Number

Address

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Village of Ada

Main Office

(419) 634-4045

115 West Buckeye Avenue
Ada, OH 45810

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