he purpose of questions 1-11 is to obtain information relevant to employment with the State of Ohio.
Responses to these questions are required.
1.Please indicate your county of residence. _________________________
2.Summary of Qualiications - In the area below, briely describe the experience, education, training and other factors that qualify you for the position or examination for which you are applying. Refer to the Minimum Qualiications and any position-speciic qualiications posted for this position or examination. If you need additional space, attach an extra sheet to this application.
3.Please list below the speciic course work areas at the high school level or beyond relevant to the position or examination for which you are applying. Also indicate the number of courses you have successfully completed in each area. Note: A transcript may not be substituted for this section, although you may be required to submit a transcript.
4.Are you a current State of Ohio employee?
___Yes, I’m a permanent employee
___Yes, I’m an interim or intermittent employee
___Yes, I’m a temporary, seasonal or project employee
___Yes, I’m a ixed term or established term employee
___No, I’m not a State of Ohio employee
5.If you are a current State of Ohio employee, please provide your eight (8) digit, OAKS ID number. If you are not a current State of Ohio employee, please type N/A. _________________________
6.If you are not a current State of Ohio employee, have you ever been employed by the State of Ohio? (If you are a current State of Ohio employee, please select N/A.)
___ Yes ___ No ___N/A
7.If you were previously employed by the State of Ohio, please choose one of the following:
___ Employment ended prior to 12-01-2004.
___ Employment ended on or ater 12-01-2004.
___ N/A - Not previously employed by the State of Ohio or current state employee.
8.If you were previously employed by the State of Ohio, have you ever plead guilty or been convicted of a misdemeanor, for violation of Ohio Revised Code 1347.15 (H)(1) and/or (H)(2) - Access rules for conidential personal information?
___ Yes ___ No
9.Have you ever been convicted of a felony? (A felony conviction may not automatically exclude you from consideration.)
___ Yes ___No
10.If you answered Yes to the previous question, please give date(s) of conviction(s) and explain. If you answered No, please type N/A.
11.How did you learn about this employment or examination opportunity?
___ careers.ohio.gov |
___ Monster.com |
___ Trade journal |
___ Walk-in |
___ Ohiomeansjobs.com |
___ Other Internet Web site |
___ State of Ohio Employee Referral |
___ Other |
___ GovernmentJobs.com |
___ Newspaper |
___ Civil Service test announcement |
|
CERTIFICATION
I certify that the answers I have made to all of the questions in this application are true and complete to the best of my knowledge. I understand that if this application is not completed in its entirety, it will not be processed and I will be automatically disqualiied. I understand that I am responsible for the correctness of this application. I also understand that a background check may be required prior to employment and that, in accordance with the Drug-Free Workplace Program, drug testing may be required. I waive all provisions of law forbidding colleges or universities which I attended, or past employers, from disclosing any information which they acquired relevant to my employment. I consent that they may disclose such information to the Human Resources Division, Ohio Department of Administrative Services, and/or the agency that holds the vacancy for which I am applying and to appropriate oicials for recruitment purposes. I understand that any ofer of employment is conditional upon proof of legal authorization to work in the United States as required by the Immigration Reform and Control Act.
Signature of Applicant _____________________________________________________________________________ Date ___________________
