Online Employment Application

1. * Address
2. * Is this a P.O. Box?

   1. Yes
   2. No
3. Apt. #
4. * City
5. * State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
6. * Zip
7. * Email
8. * Confirm Email

1. * Are you at least 18 years of age?

   1. Yes
   2. No
2. * Are you authorized to work in the U.S.?

   1. Yes
   2. No
3. Current Visa Status:
4. Expiration of employment authorization, if any: (MM/DD/YYYY)
5. * Have you ever applied for employment with Stark County Job & Family Services in the past?

   1. Yes
   2. No
6. When & What position?
7. * Have you ever been or are you currently employed by a Stark County Department/Agency?

   1. Yes
   2. No
8. If yes, list dates and name of department(s) and any other name under which you were known by Stark County
9. * Do any of your relatives work for Stark County Department/Agency or SCJFS?

   1. Yes
   2. No
10. If yes, list name, relationship and department

The following information will be used only if it is directly related to the position for which you are applying.

1. * Do you have a valid driver's license?

   1. Yes
   2. No
2. If Yes, State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
3. Year of Expiration
4. * Do you have a vehicle which you could use for work related purposes, if your job requires?

   1. Yes
   2. No
5. * Do you currently have vehicle liability insurance? (Stark County requires possession of auto insurance in accordance with ORC 4509.51 at all times.)

   1. Yes
   2. No

Use the section below to list your educational achievements including any college, technical or vocational school courses completed.

1. * Have you received your High school Diploma or GED?

   1. Yes
   2. No
1. College / University / Technical / Vocational School Name
2. Address
3. City
4. State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
5. Zip
6. Degree Awarded?

   1. Yes
   2. No
7. If Yes, what year?
8. If No, how many years completed?
9. Number of Semester Hours
10. Type of Degree Select OneNo DegreeGEDHigh School DiplomaAssociatesBachelorsMastersDoctorate
11. Major
1. College / University / Technical / Vocational School Name
2. Address
3. City
4. State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
5. Zip
6. Degree Awarded?

   1. Yes
   2. No
7. If Yes, what year?
8. If No, how many years completed?
9. Number of Semester Hours
10. Type of Degree Select OneNo DegreeGEDHigh School DiplomaAssociatesBachelorsMastersDoctorate
11. Major
1. College / University / Technical / Vocational School Name
2. Address
3. City
4. State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
5. Zip
6. Degree Awarded?

   1. Yes
   2. No
7. If Yes, what year?
8. If No, how many years completed?
9. Number of Semester Hours
10. Type of Degree Select OneNo DegreeGEDHigh School DiplomaAssociatesBachelorsMastersDoctorate
11. Major
1. College / University / Technical / Vocational School Name
2. Address
3. City
4. State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
5. Zip
6. Degree Awarded?

   1. Yes
   2. No
7. If Yes, what year?
8. If No, how many years completed?
9. Number of Semester Hours
10. Type of Degree Select OneNo DegreeGEDHigh School DiplomaAssociatesBachelorsMastersDoctorate
11. Major
2. Add additional Education Remove one

1. * Do you have a license, certification and/or registration that is pertinent to the position for which you are applying?

   1. Yes
   2. No
1. Type of License/Certification (e.g. CPA, LSW, JD, etc)
2. License/Registration No.
3. Expiration Date (MM/DD/YYYY)
4. Licensed to practice in Ohio?

   1. Yes
   2. No
1. Type of License/Certification (e.g. CPA, LSW, JD, etc)
2. License/Registration No.
3. Expiration Date (MM/DD/YYYY)
4. Licensed to practice in Ohio?

   1. Yes
   2. No
2. Add additional Certifications Remove one

Give complete information regarding present and former employment, beginning with the most recent. Please include your Military Service and any employment with Stark County. A resume may NOT be used as a substitute for completing this information.

1. * Current or Most Recent Employer
2. * Address
3. * City
4. * State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
5. * Zip
6. * Phone (999-999-9999 x9999)
7. * Your Job Title
8. * Dates of Employment. From (MM/DD/YYYY)
9. * Are you currently employed here?

   1. Yes
   2. No
10. To (MM/DD/YYYY)
11. * Salary Type

    1. hourly
    2. annual
    3. daily
12. * Salary (MAX 999,999.99, do not include $)
13. * Reason for Leaving
14. * Duties and Responsibilities (If supervisory, please indicate number and type of positions supervised)
1. Current or Most Recent Employer
2. Address
3. City
4. State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
5. Zip
6. Phone (999-999-9999 x9999)
7. Your Job Title
8. Dates of Employment. From (MM/DD/YYYY)
9. Are you currently employed here?

   1. Yes
   2. No
10. To (MM/DD/YYYY)
11. Salary Type

    1. hourly
    2. annual
    3. daily
12. Salary (MAX 999,999.99, do not include $)
13. Reason for Leaving
14. Duties and Responsibilities (If supervisory, please indicate number and type of positions supervised)
1. Current or Most Recent Employer
2. Address
3. City
4. State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
5. Zip
6. Phone (999-999-9999 x9999)
7. Your Job Title
8. Dates of Employment. From (MM/DD/YYYY)
9. Are you currently employed here?

   1. Yes
   2. No
10. To (MM/DD/YYYY)
11. Salary Type

    1. hourly
    2. annual
    3. daily
12. Salary (MAX 999,999.99, do not include $)
13. Reason for Leaving
14. Duties and Responsibilities (If supervisory, please indicate number and type of positions supervised)
1. Current or Most Recent Employer
2. Address
3. City
4. State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
5. Zip
6. Phone (999-999-9999 x9999)
7. Your Job Title
8. Dates of Employment. From (MM/DD/YYYY)
9. Are you currently employed here?

   1. Yes
   2. No
10. To (MM/DD/YYYY)
11. Salary Type

    1. hourly
    2. annual
    3. daily
12. Salary (MAX 999,999.99, do not include $)
13. Reason for Leaving
14. Duties and Responsibilities (If supervisory, please indicate number and type of positions supervised)
1. Add Additional Employer Remove one
2. * Do you have any gaps in employment?

   1. Yes
   2. No
3. Please explain any gaps in employment
4. * Have you ever been involuntarily terminated by an employer for any reason?

   1. Yes
   2. No
5. If yes, please explain
6. * May we contact your current employer?

   1. Yes
   2. No

1. Outline briefly any other skills or experience that may be helpful to us in considering your qualifications. Please include volunteer and other community activities
2. Please check all of the software programs you have used

   1. Access
   2. Excel
   3. Word
   4. Outlook
   5. PowerPoint
   6. Publisher
3. State Computer Systems

   1. CRIS-E
   2. SETS
   3. SACWIS
   4. Document Imaging System
4. List any other software programs or special machinery and equipment you have experience working with

You must provide three references to continue.

1. * Name
2. * Phone (999-999-9999 x9999)
3. * Title
4. * Company
5. * Address
6. * City
7. * State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
8. * Zip
9. * Name
10. * Phone (999-999-9999 x9999)
11. * Title
12. * Company
13. * Address
14. * City
15. * State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
16. * Zip
17. * Name
18. * Phone (999-999-9999 x9999)
19. * Title
20. * Company
21. * Address
22. * City
23. * State Select OneAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
24. * Zip

Uploads must be PDF (.pdf), Word (.doc/.docx) or OpenOffice Documents (.odt).

1. * Cover Letter
2. * Resume

AUTHORIZATION TO RELEASE INFORMATION

I am a serious applicant for employment at SCJFS. As such, I certify that the information I have provided to SCJFS both orally and in writing is accurate and complete. I authorize SCJFS and any agent acting on its behalf to confirm this information and to secure necessary information from all my employers, references, credit bureaus and academic institutions. As part of this inquiry, my complete criminal and driving records will be reviewed, civil litigation records and all records held by SCJFS will be checked. I release all of those information providers, SCJFS and any agent acting on its behalf from any and all liability arising from their giving or receiving information about my employment history, academic credentials or qualifications (except liability arising under the Fair Credit Reporting Act). I understand that this information is confidential and that disclosure of this information to me and to others will be governed by SCFJS policy and federal/state/local laws. (Please see Fair Credit Reporting Act disclosure statement)

I also understand that I have rights under the Fair Credit Reporting Act, which has been provided to me by SCJFS. This authorization will remain in effect throughout the term of employment, if hired. Any false or misleading statements I have made will be sufficient cause for rejection of my application or termination without consideration of any progressive disciplinary procedure, if hired. I have read and authorized the preceding statement.

1. * Date of Birth (MM/DD/YYYY)
2. * Full Name
3. Other Last Names Used
4. * Social Security Number (999-99-9999)
5. * County Select OneAdamsAllenAshlandAshtabulaAthensAuglaizeBelmontBrownButlerCarrollChampaignClarkClermontClintonColumbianaCoshoctonCrawfordCuyahogaDarkeDefianceDelawareErieFairfieldFayetteFranklinFultonGalliaGeaugaGreeneGuernseyHamiltonHancockHardinHarrisonHenryHighlandHockingHolmesHuronJacksonJeffersonKnoxLakeLawrenceLickingLoganLorainLucasMadisonMahoningMarionMedinaMeigsMercerMiamiMonroeMontgomeryMorganMorrowMuskingumNobleOttawaPauldingPerryPickawayPikePortagePreblePutnamRichlandRossSanduskySciotoSenecaShelbyStarkSummitTrumbullTuscarawasUnionVan WertVintonWarrenWashingtonWayneWilliamsWoodWyandot
6. Driver's License #
7. Other Cities/States you have resided during the past 7 years

APPLICANT: Please read the following statement and complete the below authorization form. Print this disclosure statement for your records.

Stark County Job & Family Services (SCJFS), when considering your application for employment, when making a decision whether to continue your employment (if hired), and when making other employment related decisions directly affecting you, may wish to obtain and use a "consumer report" from a "consumer reporting agency." These terms are defined in the Fair Credit Reporting Act (FCRA), which applies to you. As an applicant for employment or an employee of SCJFS, you are a "consumer" with rights under FCRA.

A "consumer reporting agency" is a person or business that, for monetary fees, dues, or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information on consumers for the purpose of furnishing "consumer reports" to others, such as SCJFS.

A "consumer report" is any written, oral or other communication of any information by a "consumer reporting agency" bearing on a consumer's character, general reputation, personal characteristics or mode of living which is used or collected for the purpose of serving as a factor in establishing the consumer's eligibility for employment purposes.For SCJFS purposes, a consumer report will consist of a criminal background check, employment verification, reference checking, and may consist of educational verification and civil litigation records check.

If SCJFS obtains a "consumer report" about you, and if SCJFS considers any information in the "consumer report" when making an employment related decision that directly and adversely affects you, you will be notified before the decision is finalized and you will be provided with a copy of the "consumer report." You may also contact the Federal Trade Commission about your rights under the FCRA as a "consumer" with regard to "consumer reports" and "consumer reporting agencies."

1. * I have read and agree to the Fair Credit Reporting Act and Disclosure Statement

   1. I have read and agree to the Fair Credit Reporting Act and Disclosure Statement

(CONFIDENTIAL-FOR STATISTICAL USE ONLY)

We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or any other classification protected by federal, state or local law. The information below will be used only in the compilation of data for EEO-1 reporting.

Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment, if hired. Identification can be declared at any time prior to or, if applicable, after hire.

1. Date (MM/DD/YYYY)
2. Name
3. Position Applying For
4. Social Security Number (999-99-9999)
5. Sex

   1. Male
   2. Female
6. Date of Birth (MM/DD/YYYY)
7. Zip Code
8. Race/Ethnicity (Please check one of the descriptions below corresponding to the ethnic group with which you most identify)

   1. Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
   2. White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
   3. Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.
   4. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
   5. Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
   6. American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
   7. Biracial - Consisting of, representing, or combining members of two separate racial groups; having a biological mother from one racial group and a biological father from another.
   8. Other
9. Please explain Other
10. Veteran Status (Please check one if it describes your veteran status)

    1. SPECIAL DISABLED VETERAN: Means (A) a veteran who is entitled to compensation (or who, but for the receipt of military retired pay, would be entitled to compensation) under laws administered by the Department of Veteran Affairs for a disability rated at 10 or 20 percent in the case of a veteran who has been determined to have a serious employment disability or (B) a person who was discharged or released from active duty because of a service-connected disability.
    2. VIETNAM ERA VETERAN: A Vietnam Era veteran is a person who (1) served on active duty for a period of more than 180 days, any part of which occurred between August 5, 1964, and May 7, 1975, and was discharged or released with other than a dishonorable discharge; (2) was discharged or released from active duty for a service connected disability if any part of such active duty was performed between August 5, 1964, and May 7, 1975; or (3) served on active duty for more than 180 days and served in the Republic of Vietnam between February 28, 1961, and May 7, 1975.