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General Information

Social Security #First NameMiddle InitLast Name

Present AddressCityStateZip

Yrs At AddressPhoneE-MailApplying For Position

How long have you lived in Stark County
How long have you lived in Canton
U.S. Citizen
Have you ever been indicted or convicted of a misdemeanor?
If yes, give dates and explain each occassion and disposition of the charges:
Have you ever been indicted or convicted of a felony?
If Yes were the charges reversed or annulled?
If yes, give dates, Court, and Case No.:

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 LicenseIf Yes, License No.
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Military History

Branch Of Military Service

Date Served FromDate Served To

Rank when separatedPresent 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
NameFromDegree
City & State, ToMajor / Minor

Vocational or Trade
Dates Attended
NameFromDegree
City & State, ToMajor / Minor

College
Dates Attended
NameFromDegree
City & State, ToMajor / Minor

College
Dates Attended
NameFromDegree
City & State, ToMajor / Minor

Other Training
Dates Attended
NameFromDegree
City & State, ToMajor / 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


Edit
References

NameAddressPhone NumberOccupation
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