Download - Application Form - SeasonalTemporary

BASIC EMPLOYMENT DATA

A. GENERAL INFORMATION

Name: _________________________________________________________________________________________________

Address: _______________________________________________________________________________________________

________________________________________________________________________________________________________ City State Zip Code

Phone No. ________________________________________ Work Phone No. ____________________________________

Cell/Other ________________________________________ E-Mail Address _____________________________________

Social Security No. ______________________________________________________________________________________

Military Service? YES _____ NO _____ (If yes, indicate branch, inclusive dates of service and rank at discharge.)

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Criminal Record? Have you ever been convicted of a felony? YES _____ NO _____ (If yes, explain circumstances.

Existence of a criminal record does not constitute an automatic bar to employment.) _______________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Do you have a valid Ohio Drivers License? YES _____ NO _____ (If yes, indicate type of license.)

Operators ________ Commercial Drivers License ________

State here any additional information required to answer the above questions adequately or that you feel would

be helpful for pre-employment inquiry. _____________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Are you related to any City employee? YES _____ NO _____ If so, who is the City employee or part-paid volunteer

firefighter and what is the relationship?

Are you a minor (under 18) child or stepchild of a current City of Kettering employee or part-paid volunteer

firefighter? YES _____ NO_____

If yes, name of employee or part-paid volunteer firefighter

Application for Employment Full-Time ______Part-Time ______

Temporary ______POSITION:

B. EDUCATION AND TRAINING

Check the highest school grade completed.

High School College 9 10 11 12 13 14 15 16 17 18 19 20

Degrees obtained or areas of study: _______________________________________________________________________

List any job-related schools attended or vocational training received: ________________________________________

________________________________________________________________________________________________________

Form PF-1 (10/25/12) Please complete the other sideP13-013

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C. PAST WORK EXPERIENCE(List most recent first)

Month Year Month Year Title of Your Position Annual Salary

From To

Name of Employer: _____________________________________________________________________________________

Nature of Duties: ________________________________________________________________________________________

Reason for Leaving: ______________________________________________________________________________________


From To

Name of Employer: _____________________________________________________________________________________

Nature of Duties: ________________________________________________________________________________________



From To

Name of Employer: _____________________________________________________________________________________

Nature of Duties: ________________________________________________________________________________________


Attach additional sheet of paper if necessary to report experience adequately or if you wish to include volunteer work experience.

D. REFERENCES(Relatives are not acceptable references)

Name & Title Occupation Address Phone

1.

2.

3.

4.

CERTIFICATION: I hereby certify that all the information I have provided on BOTH SIDES of this application form is true, complete and correct to the best of my knowledge and belief, and is made in good faith. I agree and understand that all statements made by me are subject to being investigated for verification. I further agree and understand that any omissions or misstatement of facts contained in this application may disqualify me for any employment or result in my removal from employment with the City of Kettering.

Signature of Applicant Date

EQUAL OPPORTUNITY EMPLOYER

As an Equal Opportunity Employer, the City of Kettering is committed to give equal consideration to all applicants without regard to race, color, religion, gender, age, national origin, ethnic heritage, or disability.

Form PF-1 (10/25/12)P13-013

BACKGROUND RELEASE FORM

PLEASE PRINT CLEARLY

NAME: ____________________________________________________________________________

ADDRESS: _________________________________________________________________________

CITY: _______________________________________ STATE: _______ ZIP: ________________

SOCIAL SECURITY NUMBER:________ - ______ - _________ CONTACT PHONE #:______________

DATE OF BIRTH: __________________ PLEASE CHECK IF YOU ARE UNDER THE AGE OF 18

DRIVERS LICENSE #: ___________________ STATE*: ______ EXP. DATE: ___________ *Applicants with out-of-state drivers licenses must provide a copy of a current driving record prior to employment.

VALID LICENSE: YES NO TYPE OF LICENSE: OPERATORS COMMERCIAL (CDL)

I authorize the City of Kettering and any investigative or credit agency of its choice, to investigate

my personal history, character and general reputation as it substantially relates to the duties and

responsibilities of the position for which I am applying, which may include my driving, safety

inspection, arrest, conviction, financial and credit record, verification of my education and

employment history, a social media search, a fingerprint background check and a search of any

public record available. These reports may be obtained at any time after receipt of my authorization

and, if hired, throughout my employment with the City of Kettering.

I authorize any reference, school, former employer, military organization, police department, or other

person or agency to disclose to the City of Kettering or its agent, upon request, any information or

records they may have about me and I release them from all liability for disclosing such information

to the City of Kettering.

I authorize the City of Kettering to obtain or cause to be prepared a consumer report or an

investigative consumer report, which may include information as to my financial and credit history,

character, general reputation, personal characteristics or mode of living, in connection with my

application for employment. ______________________________________________________ ____________________ Applicant Signature Date

______________________________________________________ ____________________

Parent/Guardian Signature if Applicant is under 18 years of age Date

Internal Use Only

DATE: ____________ BACKGROUND NEEDED BY DATE: ____________ EXPECTED HIRE DATE: ___________

DEPT:_____________POSITION_____________________________HIRING SUPERVISOR:___________________

BACKGROUND CHECK LEVEL:

FT PT TEMP CDL PS PPVF VOL CREDIT STATE FINGERPRINT FED FINGERPRINT Credit check - Positions with access to sensitive financial or personal data or at discretion of HR or Finance Dir. State fingerprint - Positions with unsupervised direct access to vulnerable populations (minors/seniors). Fed. fingerprint - FF, PPVF, Police, Dept. Directors and/or candidates who have not lived in OH for the past 5 yrs.

*All background check requirements may be modified at the discretion of the Human Resources Department.

OTHER OR NOTES_________________________________________________________________________________

BACKGROUND COMPLETED BY: ______________________________________ DATE: ___________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Approved On Hold- Please contact HR Dept. Not Recommended for Hire HR DEPT.:_________________________________________________________ DATE:___________________

PR-9445-job supplement form.doc 3/2010

City of Kettering Parks, Recreation and Cultural Arts Department

Application Supplement Name of Applicant:

Area of Interest(s):

Rank the positions you are interested in by number.

PARKS

PROGRAMMING

Mowing, Tree & Plant, Athletic Field and General Park Maintenance

Playgrounds - Sports, Arts & Crafts, Drama, Special Events

Environmental Education, camps, workshops, programs

Youth Day Camps - Outdoor Education, Sports, Arts & Crafts

FACILITY OPERATIONS After-school Youth Programming Recreation Center/Senior Center

Operations Adult Leisure & Instruction - Varied

Activities Aquatic Program - Lifeguards, Instructors

and Maintenance Adult Sports - Football, Basketball,

Softball, Volleyball Ice Arena Operations, Skating Program &

Maintenance Senior Adult Program - Varied Activities

Cashiers/Receptionists/Front Desk Operations

Fitness/Wellness - Instructors, Fitness Room Attendant

Concessions - Snack Bar Operations Special Events - Community-Wide

Recreation Aide - Set-Up, Tear-Down, Clean-Up

Preschool Instructor

Drop-in Gym Attendants - Sports & Physical Activities

Cultural Arts - Visual & Performing Arts

Nursery Bus/Van Driver (CDL needed)

Other

FRAZE PAVILION FOR THE PERFORMING ARTS

Crowd Management (security)

Box Office Clerk

Front-of-House Staff (ushers, ticket takers)

Ernies Concessions (Must be at least 21 years old)

TRAINING AND EXPERIENCE - If you have had any classes, special training, certifications and experience, a CDL drivers license or are able to teach or instruct in any of the above-mentioned areas, please list them below. List activity first; then describe types of training or experience, including any certifications. Use back of page for additional comments.

ACTIVITY TRAINING/EXPERIENCE/CERTIFICATION

Application Supplement-Parks and Rec.pdfApplication Packet - PRCAFair Credit Reporting Summary of Rights FCRA-12 pt fontold draft 5-12 Police Check Form PE-9571

Application Name: Application Address 1: Application Phone No: Application Zip code: Application City: Application State: Application Work Phone No: Application CellOther: Application EMail Address: Application Social Security No: App2 From MO/YR one: App2 To MO/YR one: App2 Title of Your Position one: App2 Annual Salary: App2 Name of Employer: App2 Nature of Duties: App2 Reason for Leaving: App2 From MO/YR two: App2 To MO/YR two: App2 Title of Your Position two: App2 Annual Salary_2: App2 Name of Employer_2: App2 Nature of Duties_2: App2 Reason for Leaving_2: App2 From MO/YR: App2 To MO/YR: App2 Title of Your Position_2: App2 Annual Salary_3: App2 Name of Employer_3: App2 Nature of Duties_3: App2 Reason for Leaving_3: App2 1: App2 2: App2 3: App2 4: App2 Date: BR NAME: BR ADDRESS: BR CITY: BR STATE: BR ZIP: BR SOCIAL SECURITY NUMBER: BR undefined: BR undefined_2: BR CONTACT PHONE: BR DATE OF BIRTH: BR PLEASE CHECK IF YOU ARE UNDER THE AGE OF 18: BR DRIVERS LICENSE: BR STATE_2: BR EXP DATE: BR Valid License:

BR OPERATORS:

BR Signature Date: BR Parents signature date: BR DATE: BR BACKGROUND NEEDED BY DATE: BR EXPECTED HIRE DATE: BR DEPT: BR POSITION: BR HIRING SUPERVISOR: BR Employment type:

BR CDL: BR PS: BR PPVF: BR VOL: BR CREDIT: BR STATE FINGERPRINT: BR FED FINGERPRINT: BR undefined_3: BR OTHER OR NOTES: BR BACKGROUND COMPLETED BY: BR DATE_2: BR Approved: BR On HoldPlease contact HR Dept: BR Not Recommended for Hire: BR HR DEPT: BR DATE_3: PRCA-Name of Applicant: PRCA-mowing: PRCA-Environmental edu: PRCA-Recreation: PRCA-Aquatic Program: PRCA-Ice Arena: PRCA-Cashier: PRCA-Concesssions: PRCA-Recreation Aide: PRCA-Drop in Gym: PRCA-Nursery: PRCA-Other: PRCA-Playground: PRCA-Youth: PRCA-Adult: PRCA-Adult sports: PRCA-Senior Adult: PRCA-Fitness wellness: PRCA-special event: PRCA-preschool: PRCA-Cultural art: PRCA-Bus: PRCA-crowd management: PRCA-Front-of-house: PRCA-Activity one: PRCA-Ernie's: PRCA-Box Office: PRCA-Training Experience: PRCA-Activity two: PRCA-Training Exp 2: PRCA-Activity three: PRCA-Training Exp 3: PRCA-Activity four: PRCA-Training four: PRCA-Reset Form: EEO-Month: EEO-Day: EEO-Year: EEO-Ethnic:

Application Military Service yes:

Application If yes indicate branch inclusive dates of service and rank at discharge 1: Application If yes indicate branch inclusive dates of service and rank at discharge 2: Application Felony yes:

Application Existence of a criminal record does not constitute an automatic bar to employment 2: Application Existence of a criminal record does not constitute an automatic bar to employment 3: Application OH Drivers License:

Application Operator's yes:

Application be helpful for preemployment inquiry 1: Application be helpful for preemployment inquiry 2: Application be helpful for preemployment inquiry 3: Application related to city employee:

Application firefighter and what is the relationship: Application firefighter:

Application If yes name of employee or partpaid volunteer firefighter: Application HS:

Application Degrees obtained or areas of study: Application List any jobrelated schools attended or vocational training received 1: Application List any jobrelated schools attended or vocational training received 2: EEO-Gender:

Download - Application Form - SeasonalTemporary

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