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Human Resources
3520 Central Parkway, Cincinnati, Ohio 45223-2690
Phone: (513) 569-1565

An Equal Opportunity Employer M/F/V/H

The Application form must be completed, and dated in order for you to receive employment consideration at Cincinnati State Technical and Community College. This application will be active for a minimum of 6 months from the date received and is not intended to be a contract of employment.

Applicants are considered for all positions without regard to race, religion, color, sex, age, national origin, handicap, marital or veteran status, sexual preference or non-job related medical condition.

Note:
Text Boxes with a ( * ) are required fields.
Please complete all information so that we may better serve you.

Date of Application: (mm/dd/yy)

How did you hear of this position?:

If other:

Please let us know if you were referred by a Cincinnati State employee:
College employee

* Applicant First Name:
* Middle Name
* Last Name
* Street Address:
* City, State, Zip
* Telephone:
* Social Security Number:
* Position (s) applied for:

E-mail address:

If employed and under 18, can you furnish a work permit?
    Yes      No   N/A

Have you previously applied for employment with Cincinnati State?
     Yes     No       If yes, give date (mm/dd/yy)

Are you employed now?
     Yes      No

Are you legally eligible for employment in the United States?
      Yes     No

* When would you be available for work? (mm/dd/yy)

* At what times are you available to work?
	Full-time	Part-time
	Shift Work	Temporary
	Day	Evening

Can you travel if the job requires it?
      Yes    No

Are you related to any Cincinnati State employee?
      Yes       No         Relationship

* Have you ever been convicted of a felony?
     Yes, please explain No

(Conviction will not necessarily disqualify applicant from employment.)

Education: Please fill in all information

	High School
School Name
Years Completed
Diploma/Degree
Describe Course of Study
Describe Specialized Training, Apprenticeship, Skills, and Extra-Curricular Activities

	College/University
School Name
Years Completed
Diploma/Degree
Year received (mm/yy)
Describe Course of Study
Describe Specialized Training, Apprenticeship, Skills, and Extra-Curricular Activities

	Graduate/Professional
School Name
Years Completed
Diploma/Degree
Year received (mm/yy)
Describe Course of Study
Describe Specialized Training, Apprenticeship, Skills, and Extra-Curricular Activities

Please enter second degree information below; for additional degrees, use certification:

	Additional Degree
School Name
Years Completed
Diploma/Degree
Year received (mm/yy)
Describe Course Of Study
Describe Specialized Training, Apprenticeship, Skills, and Extra-Curricular Activities
Certifications

Summarize the special skills and qualifications which you have acquired from employment or other experience and wish us to know as we consider you for a position at Cincinnati State Technical and Community College.

Transcripts of all completed college coursework are required and must be submitted to Human Resources. If degree is not confirmed, a second transcript will be required upon graduation.

Experience: Begin with your present or most recent job. You may include military service assignments and volunteer activities and exclude organization names which indicate race, color, religion, sex, or national origin. A resume may be included with this section, but may NOT replace it. Please fill in all information, including months and years employed with each employer.

CURRENT/MOST RECENT Employer	Date Employed
	From (mm/yy) To (mm/yy)
Address and Phone Number

Job Title
	Hourly Rate/ Salary
Supervisor	Starting Final

Reason for Leaving

Work Performed

NEXT RECENT Employer	Date Employed
	From (mm/yy) To (mm/yy)
Address and Phone Number

Job Title
	Hourly Rate/ Salary
Supervisor	Starting Final

Reason for Leaving

Work Performed

Employer	Date Employed
	From (mm/yy) To (mm/yy)
Address and Phone Number

Job Title
	Hourly Rate/ Salary
Supervisor	Starting Final

Reason for Leaving

Work Performed

Please use, if additional space is needed:

May we contact your previous employers listed above?
Yes No

May we contact your current employer?
Yes No

If no, to either of the above questions, give reason:

List professional, trade, business, or civic activities and offices held.
(You may exclude those which indicate race, color, religion, sex or national origin):

Give name, address, and telephone number of three references who are not related to you and are not previous employers.

	First Reference
*Name
*Address
*City/State/Zip
*Phone

	Second Reference
*Name
*Address
*City/State/Zip
*Phone

	Third Reference
*Name
*Address
*City/State/Zip
*Phone

Applicant's Certification and Agreement

I certify that the facts set forth in the above employment application and any addenda are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal.

If I am hired, I understand that I am required to abide by all rules and regulations of the College. I agree that my employment is for no definite period of time unless negotiated by contract and may be terminated, with or without cause or notice, at any time and for any reason, by the College.

I understand that no representative of the College has the authority to enter into any employment agreement contrary to the foregoing, except the President of the College in writing.

I agree that when my employment is terminated by retirement or otherwise, I must return all the employer's property in my custody including, but not limited to, keys, manuals, books and equipment, before I am entitled to final payment of any amount due me on separation.

YOU ARE HEREBY AUTHORIZED TO MAKE ANY INVESTIGATION OF MY PERSONAL HISTORY INCLUDING WORK HISTORY, POLICE BACKGROUND AND CONVICTION RECORD, AND CREDIT RECORD THROUGH ANY INDIVIDUAL, FORMER EMPLOYER, INVESTIGATIVE OR CREDIT AGENCIES OR BUREAUS OF YOUR CHOICE. I understand that this information is confidential, and I hereby release Cincinnati State Technical and Community College, it's safety department, and all individuals connected therewith from all liability related to the release of these records, If a report is obtained, you must provide, at my request, the name of the agency so I may obtain from them the nature and substance of the information contained in the report.

   * I agree with the Applicant's Certification and Agreement as stated above.
  (mm/dd/yy) Date

You will be requested to sign this Applicant's Certification and Agreement upon interviewing for an employment opportunity at Cincinnati State.