Employment Application

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    Present to Past Three (3) Employers

    Fill Out the following employment record, giving your last three (3) places of employment. (Please begin with present employer)

    #1 Employer

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    #2 Employer

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    #3 Employer

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    REFERENCES

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    Disclosures

    Prior to actual employment and consistent with provisions of O.R.C. 109.57, verification of the response to this question will be obtained from the Ohio bureau of Criminal Identification and Investigation and other agencies, The verification process will require submission of fingerprints. Information obtained about convictions/charges will be evaluated to determine whether the nature of the offense in manifestly inconsistent with the position sought. I hereby declare the information provided by me in this application for employment is true, correct and complete to the best of my knowledge. I authorize you to obtain an investigative report to verify the statements made herein using information obtained through personal acquaintances, references, a check of criminal convictions and from any other source deemed appropriate. If position requires operation of vehicle for company business, I authorize you to obtain a copy of my traffic records through local authorities as well as the Bureau of Motor Vehicles. I understand that if employed, any misstatement or omission of fact on this application shall be considered cause for automatic dismissal.