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2. THE CITY OF SPRINGBORO IS AN EQUAL OPPORTUNITY EMPLOYER

   This is the first step in applying for a position with the City of Springboro. 

   Questions regarding your application should be  directed to Greg Shackelford or call 937-748-4352.

4. Position(s) applied for:*
5. Date of application*
   Date of application
7. Last Name:*
9. First Name:*
10. Middle Name:*
12. Email Address*
14. Address:*
15. City:*
17. State:*
18. Zip:*
20. Phone:*
22. If you are under 18 years of age, can you furnish a work permit?*
    -- Select One --YesNo
24. Have you ever been employed with the City of Springboro before?*
    -- Select One --YesNo
26. Are you eligible for continued employment in the United States?*
    -- Select One --YesNo
28. Date available for work:*
    Date available for work:
29. Salary Expected:*
30. Type of Employment Desired:*
    -- Select One --Full TimePart TimeSeasonal
32. Will you submit to any pre-employment testing designed to determine whether you are able to perform the essential functions of the job for which you are applying?*
    -- Select One --YesNo
34. Do you have any relatives employed by the City of Springboro?*
    -- Select One --YesNo
35. If you answered "Yes," what is your relationship to the employee

37. EDUCATION

39. What high school did you attend?*
41. Did you graduate?*
    -- Select One --YesNo
43. College/University*
    -- Select One --01234

    Years Completed

44. Course(s) of Study & Describe any Training and Skills*
45. Did you graduate?*
    -- Select One --YesNo
47. Graduate/ Professional*
    -- Select One --01234

    Years Completed

48. Course(s) of Study & Describe any Training and Skills*
49. Did you graduate?*
    -- Select One --YesNo

51. EMPLOYMENT HISTORY
    List your last three (3) employers, assignments or volunteer activities, starting with the most recent. 

53. EMPLOYER:*
54. Job title:*
56. Dates worked at this location:*
    Dates worked at this location: Start Date

    —

    Dates worked at this location: End Date
58. Employer Address:*
59. Immediate Supervisor:*
61. Employer Phone Number:*
62. May we contact this supervisor?*
    -- Select One --YesNo
64. Summarize the nature of work performed and your job responsibilities: *
66. Reason for leaving:*
67. Final Hourly Rate or Salary:*
69. EMPLOYER:*
70. Job title:*
72. Dates worked at this location:*
    Dates worked at this location: Start Date

    —

    Dates worked at this location: End Date
74. Employer Address:*
75. Immediate Supervisor:*
77. Employer Phone Number:*
78. May we contact this supervisor?*
    -- Select One --YesNo
80. Summarize the nature of work performed and your job responsibilities: *
82. Reason for leaving:*
83. Final Hourly Rate or Salary:*
85. EMPLOYER:*
86. Job title:*
88. Dates worked at this location:*
    Dates worked at this location: Start Date

    —

    Dates worked at this location: End Date
90. Employer Address:*
91. Immediate Supervisor:*
93. Employer Phone Number:*
94. May we contact this supervisor?*
    -- Select One --YesNo
96. Summarize the nature of work performed and your job responsibilities: *
98. Reason for leaving:*
99. Final Hourly Rate or Salary:*

101. I certify that the information contained in this application is true to the best of my knowledge and belief. I understand that any misrepresentation of fact, as stated or implied, on this or any other employment form, may subject me to disciplinary action, up to and including termination of employment. Employment with the City is at-will, unless otherwise governed by statute, regulation or ordinance.  

     I understand the City is in no way obligated to provide employment and that I am in no way obligated to accept employment. This application does not bind either party for a specific period of time regarding employment and the statements herein do not constitute any sort of contract of employment.

     I understand investigation of all statements contained in this application for employment may be necessary in arriving at an employment decision by the City.

103. Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
105. Electronic Signature*
106. Date*
     Date
Leave This Blank:


108. 1. Receive an email copy of this form.
109. Email address

     This field is not part of the form submission.

110. Submit

* indicates a required field