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2. 
4. Position Applying For:
5. Date of Application (MMDDYYYY)
7. Name
8. Email Address
10. Address
12. City
13. State
14. Zip Code
16. Phone Number
20. Have you ever submitted an application with us before?

    1. Yes
    2. No
21. If yes, give approximate date:
23. Have you ever been employed with us before?

    1. Yes
    2. No
24. If yes, give dates:
26. May we contact your present employer?

    1. Yes
    2. No
27. Are you 18 years of age or older?

    1. Yes
    2. No
29. Can you provide proof of eligibility for employment in the U.S.?

    (Proof of citizenship or immigration status will be required upon employment.)

    1. Yes
    2. No
30. Do you have a valid driver's license?

    1. Yes
    2. No
32. License Number
33. State
34. Class
36. On what date would you be available for work?
37. Are you available to work:

    1. Full Time
    2. Part Time
    3. Temporary
    4. No. of Hours

39. WE ARE AN EQUAL OPPORTUNITY EMPLOYER

43. Education and Training
45. Do you possess a high school diploma or equivalent education?

    1. Yes
    2. No
46. Indicate last level completed:

    1. High School
    2. Technical School
    3. College or University
    4. Graduate School
48. Technical School
49. City, State
50. Program
51. Did you graduate?

    1. Yes
    2. No
53. College/University
54. City, State
55. Degree
56. Did you graduate?

    1. Yes
    2. No
58. College/University
59. City, State
60. Degree
61. Did you graduate?

    1. Yes
    2. No
63. Describe any specialized training, apprenticeships, skills, extra-curricular activities, or honors.
65. List any professional or trade licenses or certifications that are relevant to the position for which you are applying.
69. Specialized Skills
71. Check Skills/Equipment Operated

    1. PC
    2. Microsoft Office Suite
    3. ArcGIS
    4. BS&A or other municipality software
72. Do you have a valid CDL (Commercial Driver’s License):

    1. Yes
    2. No
73. Heavy/Light Equipment and Motor Vehicles and Other Equipment Operated (Please List):
77. List Professional, Trade, Business or Civic Activities and Office(s) Held

    You may exclude memberships that would reveal sex, race, religion, national origin, age, weight, marital status, disability, or other protected status.

79. Additional Information

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

83. Military Service Record
85. Have you had any experience in the Armed Forces of the United States or in the National Guard?

    1. Yes
    2. No
86. If yes, what branch?
87. Rank at discharge:
89. Type of discharge:
90. Date of discharge:
91. Are you in the Reserves?

    1. Yes
    2. No
92. If yes, date obligation ends:
94. Describe any job-related training received in the United States military.
98. Employment History

    Please list your most recent employer first.

100. Company/Employer's Name
102. Start Date
103. Ending Date
105. City
106. State
108. Starting Salary
109. Ending Salary
111. Your Job Title
112. Reason for Leaving
114. If not submitting a resume, briefly describe the nature and duties of your position
118. Company/Employer's Name
120. Start Date
121. Ending Date
123. City
124. State
126. Starting Salary
127. Ending Salary
129. Your Job Title
130. Reason for Leaving
132. If not submitting a resume, briefly describe the nature and duties of your position
136. Company/Employer's Name
138. Start Date
139. Ending Date
141. City
142. State
144. Starting Salary
145. Ending Salary
147. Your Job Title
148. Reason for Leaving
150. If not submitting a resume, briefly describe the nature and duties of your position
154. References

     Please list three (3) persons who have knowledge of your experience and qualifications for this position. Do not include relatives. If you are known to your references by another name, please note.

156. Name
157. Email Address
158. Phone #
159. Business Relationship
161. Name
162. Email Address
163. Phone #
164. Business Relationship
166. Name
167. Email Address
168. Phone #
169. Business Relationship
171. Upload Resume (optional)
173. Upload Cover Letter (optional)
175. Read Carefully and Sign

     I certify that the information contained in this application is true and correct to the best of my knowledge, and I understand that any misstatement or omission of information is grounds for ending the hiring process or dismissal. 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 educational institutions 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 appropriate officials for recruitment purposes. I further agree that either I, or the City of Tipp City, may terminate my employment with or without cause and with or without prior notice, at any time. Finally, I understand that any information provided that was not specifically requested will invalidate the application.

177. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
179. Electronic Signature
180. Date
Leave This Blank:


182. 1. Receive an email copy of this form.
183. Email address

     This field is not part of the form submission.

184. Submit Submit and Print

* indicates a required field