Franklin County Court of Common Pleas
General Division - Employment Application

04/24/2018
First Name: Middle Name: Last Name:
Home/Business Phone: Email Address:
Street Address:
City: State: ZipCode:
If you have lived at the above address for less than six months, list your previous address:
Are you currently eligible (by reason of citizenship or legal alien status) for employment in the United States?
Is your residency in the U.S. based on a student visa? (Proof of citizenship or immigration status will be required upon employment)
Will you require employer sponsorship in order to remain eligible for work in the United States?
(Applicants must be presently authorized to work in the United States on a full-time basis.)
Have you worked under a different last name than currently used? If yes, provide name:
If you are under 18 years of age, do you have a work permit?
Have you ever applied for employment with the Franklin County Courts? If yes, when?
Have you ever been employed by the state, city, township, or county service of Ohio? If yes, give dates of employment: Position(s) Held?
Are you related to anyone currently employed with the Franklin County Courts? If yes, give name: Relationship to you:
How were you referred to Franklin County Courts?
By Who ?
Position Applied For: Type of Position:
PLEASE INDICATE HOURS YOU PREFER AND/OR ARE AVAILABLE TO WORK:
Monday Tuesday
Wednesday Thursday
Friday Saturday
Sunday
Salary Requirements: Available Employment Date:
How many hours per week do you prefer?
Would you be willing to work additional hours?
Are there any limitations on your working hours? If yes, please explain
Are you available to work nights?
Education
High School Name: Did you graduate?
Street Address:
City: State: ZipCode:
Course of Study:
College Attended: Degree Obtained:
Name & Major of Degree:
Street Address:
City: State: ZipCode:
College Attended: Degree Obtained:
Name & Major of Degree:
Street Address:
City: State: ZipCode:
College Attended: Degree Obtained:
Name & Major of Degree:
Street Address:
City: State: ZipCode:
Extracurricular Activities:
(You may exclude any organization in which the name or character of the organization indicates the race, color, religion, national origin, sex, veteran status, ancestry, disability, marital status, or any other classification protected by federal, state, or local law.)
Honors and Achievements:
List any courses taken that may be applicable to the position for which you are applying:
Use the space provided to list additional interests, skills, or qualifications that you possess that you feel qualify you for the position for which you are applying.

Check All Applicable Skills:

Number of Years



WPM












Other PC Software:


, Number of Employees:
















Expiration Date:

Employment History
If a resume accompanies this application, please complete the parts in bold typeface and indicate the attachment of your resume.
Please list all jobs held within at least, the last ten (10) years, beginning with your present or most recent job. Include all self-employment, voluntary work, and military work experience. Use the space provide at the bottom of this application if necessary.
Employer: Type of business:
Telephone #
Street Address:
City: State: ZipCode:
Employed From(MM/YY): To(MM/YY): Salary: Beginning:
Ending:
Title of Position: Supervisor:
Description of work:
Reason for leaving:
Employer: Type of business:
Telephone #
Street Address:
City: State: ZipCode:
Employed From(MM/YY): To(MM/YY): Salary: Beginning:
Ending:
Title of Position: Supervisor:
Description of work:
Reason for leaving:
Employer: Type of business:
Telephone #
Street Address:
City: State: ZipCode:
Employed From(MM/YY): To(MM/YY): Salary: Beginning:
Ending:
Title of Position: Supervisor:
Description of work:
Reason for leaving:
If any of the employers identified above were asked why you left, would their answers be the same as yours? If no, please explain:
Were you involuntarily terminated from any previous position? If yes, please explain:
Can we contact your previous employers? If no, please explain:
ONLY FOR THOSE APPLYING FOR A POSITION INVOLVING DRIVING
Do you have a valid drivers license? State of Issuance:
Drivers License #: Expiration Date:
Professional References: Names of Non-relatives who can provide Professional References.
Name: Years Known:
Street Address:
City: State: ZipCode:
Telephone Number: Occupation:
Name: Years Known:
Street Address:
City: State: ZipCode:
Telephone Number: Occupation:
Name: Years Known:
Street Address:
City: State: ZipCode:
Telephone Number: Occupation:



Please attach your cover letter, resume, or additional information below.
Certification
Please read carefully. If you have any questions regarding this statement, please discuss them with the Interviewer before signing:

In the event of my employment, I agree to conform with the policies and any other rules and regulations of the Franklin County Court of Common Pleas and acknowledge that these rules and regulations may be changed, interpreted, withdrawn, or added at the sole option of the Franklin County Court of Common Pleas without prior notice to me. I understand that this application will be given every consideration but its receipt does not imply that I will be employed. I understand that this employment application and any other Franklin County Court of Common Pleas documents are contracts for employment, and that my employment will be employment at will and can be terminated at any time, with or without cause or notice, at the option of Franklin County Court of Common Pleas or myself. If hired, I understand that no modification or alteration of my employment at will status shall be valid or binding, unless it is expressly set forth in a written document by the Director of Human Resources.
Initials

I understand that Franklin County Court of Common Pleas may require me to undergo a drug screen by medical staff and/or agent selected by the Franklin County Court of Common Pleas as a condition of my employment and/or continued employment in Probation. I consent to the release of my drug test results to the Franklin County Court of Common Pleas. I further understand that I must successfully pass the drug test to be considered for employment in the specified units. I further release the Franklin County Court of Common Pleas, including all its appointed officials, agents, representatives and employees from any and all claims, suits, causes of action, liabilities and damages associated with or arising from by submission to a drug test.
Initials

I understand that Franklin County Court of Common Pleas maintains a restricted smoking environment.
Initials

I certify that the information in this application is correct and complete. I understand that if offered employment, that my employment is contingent on completing all aspects of the pre-employment and reference checking processes.
Initials

/s/
Applicant Signature
Date