Application - Civil Service

General Information

Social Security #	First Name	Middle Init	Last Name

Present Address	City	State	Zip

Yrs At Address	Phone	E-Mail	Applying For Position

How long have you lived in Stark County
How long have you lived in Canton
U.S. Citizen
The Civil Service Law prohibits classified employees from holding any position in a political office or club. Do you belong to any organization of this type at the present time?
Are you an elected official such as a precinct committee person?

I am available for employment as follows:
Temporary	Full-Time	Part-Time	Seasonal

Do you have a driver's license?
Do you have a Commercial Driver's License		If Yes, License No.

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Military History

Branch Of Military Service

Date Served From

Date Served To

Rank when separated	Present Reserve Status

Describe any training or honors recieved in Military:

Describe duties:

Did you serve at least 180 days of consecutive active duty service?
If yes, were you honorably discharged?

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Education

High School

		Dates Attended
Name		From	Degree
City & State	,	To	Major / Minor

Vocational or Trade

		Dates Attended
Name		From	Degree
City & State	,	To	Major / Minor

College

		Dates Attended
Name		From	Degree
City & State	,	To	Major / Minor

College

		Dates Attended
Name		From	Degree
City & State	,	To	Major / Minor

Other Training

		Dates Attended
Name		From	Degree
City & State	,	To	Major / Minor

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Other Skills

Office Machine Operated:

Factory, construction or street equipment operated:

Typing Speed

W.P.M.

Shorthand Speed

W.P.M.

Describe any other Special Training and / or skills which are related to the kind of work you want to do:

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Employment History

Would you object to the City's contacting your present employer for a reference

List your employment starting with your most recent

First

Dates Employed To	May we contact?
	Phone

Employer

Address

City, State Zip
,

Name Of Supervisor

Your Title

Your Duties

# Of Workers You Supervised

Hrs / Week

Salary Per

Reason For Leaving

Second

Dates Employed To	May we contact?
	Phone

Employer

Address

City, State Zip
,

Name Of Supervisor

Your Title

Your Duties

# Of Workers You Supervised

Hrs / Week

Salary Per

Reason For Leaving

Third

Dates Employed To	May we contact?
	Phone

Employer

Address

City, State Zip
,

Name Of Supervisor

Your Title

Your Duties

# Of Workers You Supervised

Hrs / Week

Salary Per

Reason For Leaving

Fourth

Dates Employed To	May we contact?
	Phone

Employer

Address

City, State Zip
,

Name Of Supervisor

Your Title

Your Duties

# Of Workers You Supervised

Hrs / Week

Salary Per

Reason For Leaving

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References

Name	Address	Phone Number	Occupation

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