Form Center

Personal Information

First Name*
Last Name*
Address*
City*
State*
Zip*
Email Address*
Phone Number*
Are you 18 years old or older?*
1. Yes
1. No
Have you ever been convicted of a criminal or serious traffic offense?*
1. Yes
1. No
If yes, please explain.*
Are you prevented from lawfully becoming employed in this country because of VISA or Immigration status?*
1. Yes
1. No
Are any of your relatives currently a city employee or serving on a city board or commission?*
1. Yes
1. No
If yes, please name.*
Driver's License Number*
Type of License*
1. Operator
2. CDL
If CDL, list class and endorsements*
Employment Desired
Position*
Available Start Date*
Available Start Date
Desired Salary*
Have you previously applied for employment with the City?*
1. Yes
2. No
If yes, when and for what position?*
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Education

High School Name & Location
Did you graduate?
1. Yes
1. No
Diploma/Degree or Credit Hours
College/University Name & Location
Did you graduate?
1. Yes
1. No
Diploma/Degree or Credit Hours
College/University Name & Location
Did you graduate?
1. Yes
1. No
Diploma/Degree or Credit Hours
Trade/Business School Name & Location
Did you graduate?
1. Yes
1. No
Diploma/Degree or Credit Hours
Additional Experience
Are there any other experiences, skills, or qualifications which you feel would qualify you for work with the City of Chardon?
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Military Service

Branch
Rank at Discharge
Service Dates
Service Dates Start Date
—
Service Dates End Date
Type of Discharge
If other than honorable, please explain.
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Previous Employment

Company*
Phone Number*
Employment Dates*
Employment Dates Start Date
—
Employment Dates End Date
Address*
Job Title*
Starting Salary*
Ending Salary*
Reason For Leaving*
May we contact your previous supervisor for a reference?*
1. Yes
1. No
Company
Phone Number
Employment Dates
Employment Dates Start Date
—
Employment Dates End Date
Address
Job Title
Starting Salary
Ending Salary
Reason For Leaving
May we contact your previous supervisor for a reference?
1. Yes
1. No
Company
Phone Number
Employment Dates
Employment Dates Start Date
—
Employment Dates End Date
Address
Job Title
Starting Salary
Ending Salary
Reason For Leaving
May we contact your previous supervisor for a reference?
1. Yes
1. No
Resume
If you would like to attach a resume, please do so here.
Cover Letter
if you would like to attach a cover letter, please do so here.
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References

Name*
Address*
Phone*
Business Phone*
Years Known*
Name
Address
Phone
Business Phone
Years Known
Name
Address
Phone
Business Phone
Years Known
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Disclaimer & Signature

Disclaimer
I certify that all the information in this application is true and complete. I acknowledge that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated.

In consideration of my employment, I agree to conform to the City of Chardon's rules and regulations. I agree that my employment and compensation can be terminated with or without cause, with or without notice and at any time by the City of Chardon. I acknowledge and agree that the terms and conditions of my employment may be changed with or without cause and with and without notice at any time by the City of Chardon. I understand that only the city Manager has the authority to enter into any agreement for employment in writing, for any specific period of time, or to agree to terms and conditions contrary to the foregoing.
Electronic Signature*
By checking this box, I am providing my electronic signature. I may be asked to provide a physical signature at a later date.
1. I understand and agree.
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Applicant Release of Information Agreement

I,*
currently residing at*
have applied for employment with the City of Chardon. I have been advised and am fully aware that a representative of the City of Chardon will be conducting a thorough investigation of my background to assist in determining my suitability for this position. I realize that, in conducting this background investigation, officers will be making inquiries of, and requesting records from schools that I have attended; police or courts with whom I may have an arrest or conviction record; credit bureaus and/or firms that may have information regarding my credit record and/or financial standing/ present and previous employers; and any other persons who may be able to provide information about me.

I hereby consent to this investigation and waive all privilege and confidentiality that prevent provisions of law, school official, court, police agency, credit bureau, employer, firm or person, from disclosing any records or information they have concerning me which is requested or desired by the City of Chardon. I further consent to the Chardon City Manager or his representative being provided with a copy of any such record concerning me.

I recognize the right of the City of Chardon to treat, at its discretion, certain sources as confidential and its right to withhold from me or my agent the names of such confidential sources and information obtained therefrom.
Electronic Signature*
1. I understand and agree.
By checking this box, I am providing my electronic signature I may be asked to provide a physical signature at a later date.
Date*
Date
It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin or other protected classification.
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Voluntary Equal Employment Opportunity Self Identification