Application for Employment


Please list employment history with most recent first. Must include phone numbers.

Employer Information (1)

(if the above is not checked, all fields in this section are required)

(mo/yr)
(mo/yr)

Employer Information (2)

(if the above is not checked, all fields in this section are required)

(mo/yr)
(mo/yr)

Employer Information (3)

(if the above is not checked, all fields in this section are required)

(mo/yr)
(mo/yr)
(mo/yr)
(mo/yr)

I solemnly swear and affirm that I read this employment application in its entirety. The answer to each and every question and any additional statements and/or materials submitted with this application are true and accurate to the best of my knowledge and belief. I understand and agree that the submission of any false and/or misleading statements or the failure to disclose relevant information deemed material to the application process - no matter when discovered - may result in my disqualification for employment or termination of my continued employment, at the discretion of the Board.

I authorize the Board to make whatever inquiries it considers necessary and appropriate of any person or organization to verify any of the information I have provided in this application and to determine my experience, qualifications, skills and abilities. I grant permission for this application and attachments, if any, to be duplicated and distributed to Board employees responsible for reviewing, interviewing and recommending applicants for employment and to Board employees responsible for personnel records.

I hereby waive all provisions of the law forbidding colleges or universities which I have attended, or past employers, from disclosing any knowledge or information which they thereby acquired relevant to my employment, and I hereby consent to their disclosure of such knowledge or information to the Board, its authorized employees or to the Division of Personnel, Ohio Department of Administrative Services without my prior notice.

I understand that the Board is required by Ohio law to conduct a record check of the criminal conviction history of an applicant under final consideration for employment with the Board. Ohio law and Board policy make applicants with certain criminal conviction histories ineligible for employment. I understand that if requested I will be required to complete an affidavit regarding my criminal conviction history and be fingerprinted. The criminal conviction record check will be conducted by the Ohio Bureau of Criminal Investigation and Identification which may include information from the Federal Bureau of Investigation and, at the Board’s discretion, other state and/or federal agencies. The report of my criminal conviction history, if any, may be made available (Pursuant to Section 5126.28 (c) of the Ohio Revised Code) to Board members, Board employees responsible for employment decisions or any hearing officer in the case of denial of employment. I will be provided with a copy of the report. I understand and agree that my eligibility for employment is subject to and conditioned upon review and evaluation of the criminal conviction history, if any, contained in the report.

I understand and agree that all offers of employment are subject to and conditioned upon the results of a pre-employment physical, including a drug test and tuberculosis test or chest x-ray, verifying my fitness for duty and ability to perform the essential functions of the position with or without reasonable accommodation.

I understand and agree, that as a condition of employment and continued employment, I shall meet and maintain any and all required standards for my position, including but not limited to certification, registration, licensure and/or training. I further understand and agree that in order to renew a certification, registration or licensure, or otherwise as a condition of continued employment, I may be required to enroll in and successfully complete college courses, classes, seminars and/or other job-related training which may be at my expense.

I am prepared to offer documentation of my right to work in the United States.


Please type your full name in the field above to sign.

(Month Day, Year)

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Applications must be completed entirely to be considered for employment