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MH Employment Application (Full-Time)

Steps

1. Step One This section is complete This section is incomplete
2. Personal Information This section is complete This section is incomplete
3. Employment History/Experience This section is complete This section is incomplete
4. Education and Training This section is complete This section is incomplete
5. References This section is complete This section is incomplete
6. Acknowledgements This section is complete This section is incomplete

Step One

City of Mayfield Heights
Employment Application
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Personal Information

Position Sought*
First Name*
Middle Initial
Last Name*
Home Address*
City*
State*
Zip Code*
Home Phone No.*
Mobile Phone No.*
Email Address
Are you an adult?*
Are you eligible to work in the United States?
Are you related to anyone who works for the city?
If yes, state the employee name and relationship
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Employment History/Experience

List all employment history and work experience in chronological order with most recent first. Failure to include all employment may be grounds for disqualification.
Current Employer (Enter "None" if unemployed)
May we contact your current employer?
Street Address
City
State
Zip Code
Phone No.
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Job Title
Supervisor's Name
Beginning Salary
Current Salary
Describe your duties, responsibilities, equipment operated, promotions, etc.
Why do you want to leave?
Previous Employer
Street Address
City
State
Zip Code
Phone No.
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Job Title
Supervisor's Name
Beginning Salary
Ending Salary
Reason for leaving?
Previous Employer
Street Address
City
State
Zip Code
Phone No.
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Job Title
Supervisor's Name
Beginning Salary
Ending Salary
Reason for leaving?
Previous Employer
Street Address
City
State
Zip Code
Phone No.
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Job Title
Supervisor's Name
Beginning Salary
Ending Salary
Reason for leaving?
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Education and Training

High School Attended
Street Address
City
State
Zip Code
Phone No.
Did you graduate?
College or Trade School Attended
Street Address
City
State
Zip Code
Phone No.
Did you graduate/complete course?
Degree/Certification Obtained
Knowledge, skills and abilities and experience essential to the functions of the position you are seeking
Exclude membership in professional organizations and offices held the name or character of which indicates the race, color, religion, sex, national origin, handicap, age or ancestry of its members.
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References

Please list three professional references who are not related to you that you have known for at least one year.
1. Name
Street Address
City
State
Zip Code
Phone No.
2. Name
Street Address
City
State
Zip Code
Phone No.
3. Name
Street Address
City
State
Zip Code
Phone No.
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Acknowledgements

Please read each of the following paragraphs carefully. Indicate your understanding of, and consent to, the contents and conditions of each paragraph by placing your initials as indicated. If you have any questions regarding these paragraphs, contact the employer before initialling.
I understand, and accept that, if I am selected for employment, my employment may be conditioned upon my passing any medical examination that the employer deems necessary to determine whether I can physically perform the essential functions of the position, with reasonable accomodation when necessary. I understand and accept that this may include drug, alcohol or substance abuse testing.
Initials*
I accept and understand that my future employment with the employer will be jeopardized if I engage in substance abuse, illegal drug use, or alcohol abuse.
Initials*
I understand and accept that the employer requires a high degree of integrity and confidentiality of its employees. I also understand and accept that the various law enforcement and information agencies that exchange information and data with the employer require that the employer's employees do not have a past record of unlawful activities. Therefore, I understand and accept that, depending on the department in which I am applying for employment, it may be necessary for the employer to investigate my background for any criminal or unlawful activity.
Initials*
If employed, I understand and accept that, depending on the department in which I am applying for employment, I may be required to work evening shifts or night shifts, including weekends, and be on call and work mandatory overtime hours.
Initials*
If employed, I understand and accept, that if this position requires a valid driver's license, proof will be required.
Initials*
I hereby authorize the employers, schools and personal references named in this application to provide information regarding me to the employer. I further authorize the release of personnel, academic and other records to the employer.
Initials*
I understand and accept that if any information required in this application is found to be falsified or intentionally excluded, my application may be disqualified from further consideration. I further understand and accept that If I am employed by the employer, I may be subject to disciplinary action, including termination, if any information required by this application has been falsified or intentionally excluded.
Initials*
This application will be considered active for 12 months from the date filled. If you are hired, it will become a part of your official employment record.
Initials*
Read carefully before signing
I solemnly swear that all of the information furnished in this employment application is true, accurate, and complete to the best of my knowledge. I authorize investigation of all my statements contained in this application. I understand that any misrepresentation or falsification of the information provided may lead to withdrawal of an employment offer or termination following employment.

I agree that any claim or lawsuit relating to my service with the city must be filed no more than six (6) months after the date of the employment action that is the subjecct to the claim or lawsuit. I waive any statute of limitations to the contrary.
Applicant's Signature
Date
Date
The City of Mayfield Heights is an Equal Opportunity Employer
If you require accomodations to complete this application, please email ra@mayfieldheights.org.

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MH Employment Application (Full-Time)

Steps

Step One

Personal Information

Employment History/Experience

Education and Training

References

Acknowledgements

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