Corrections Employment Application

Hocking County Sheriff's Office · 16759 Snake Hollow Road, Nelsonville, Ohio 45764 · Phone (740) 385-2131 · Fax (740) 380-4139

This is the same application as the printed form, built to be filled out with a keyboard and read by a screen reader. Complete the fields below, then choose Print / Save as PDF and email the finished application to lbickel@hocking.oh.gov, or mail it to HR Officer, 25 East Second Street, Logan, Ohio 43138.

Nothing you type is sent anywhere from this page. Your answers stay in your browser until you print or save the form. Prefer paper? Download the original PDF.

General Information

Employment History

Begin with your last or most recent employer and include all employers. If you need more space, attach a separate sheet or list the remaining employers in the additional information box at the end of the form.

Employer 1

Agency name

Position title

Address

City / State / ZIP

Dates employed

Starting salary

Ending salary

Agency telephone

Immediate supervisor

Number of employees you supervised

Reason for leaving

May we contact this employer for references and/or verification?

Yes No

Major duties

Employer 2

Agency name

Position title

Address

City / State / ZIP

Dates employed

Starting salary

Ending salary

Agency telephone

Immediate supervisor

Number of employees you supervised

Reason for leaving

May we contact this employer for references and/or verification?

Yes No

Major duties

Employer 3

Agency name

Position title

Address

City / State / ZIP

Dates employed

Starting salary

Ending salary

Agency telephone

Immediate supervisor

Number of employees you supervised

Reason for leaving

May we contact this employer for references and/or verification?

Yes No

Major duties

Employer 4

Agency name

Position title

Address

City / State / ZIP

Dates employed

Starting salary

Ending salary

Agency telephone

Immediate supervisor

Number of employees you supervised

Reason for leaving

May we contact this employer for references and/or verification?

Yes No

Major duties

Employer 5

Agency name

Position title

Address

City / State / ZIP

Dates employed

Starting salary

Ending salary

Agency telephone

Immediate supervisor

Number of employees you supervised

Reason for leaving

May we contact this employer for references and/or verification?

Yes No

Major duties

Employer 6

Agency name

Position title

Address

City / State / ZIP

Dates employed

Starting salary

Ending salary

Agency telephone

Immediate supervisor

Number of employees you supervised

Reason for leaving

May we contact this employer for references and/or verification?

Yes No

Major duties

Education

Do you have a high school diploma?

Yes No

Date received

Name and location of high school attended

Do you have a GED?

Yes No

Date received

Highest grade completed

College course work

1. Name and location of institution, degree received (if any), major or specialty, dates attended

2. Name and location of institution, degree received (if any), major or specialty, dates attended

Certifications and/or licenses applicable to this position

Skills

Specify skills you have that are applicable to this position (technical, clerical, medical, formal training, and so on)

Typing / keyboarding words per minute

Check all that apply

Personal computer Shorthand Microsoft Word

Other skills (list)

References

List people who can provide work-related information and vouch for your integrity and professionalism, such as a former employer or co-worker.

Reference 1 – name

Reference 1 – agency and title

Reference 1 – daytime phone

Reference 1 – relationship

Reference 2 – name

Reference 2 – agency and title

Reference 2 – daytime phone

Reference 2 – relationship

Reference 3 – name

Reference 3 – agency and title

Reference 3 – daytime phone

Reference 3 – relationship

Do you have any friends or family members employed at the Hocking County Sheriff’s Office?

Yes No

If yes, who, and what is your relationship with the employee?

Certification

I hereby certify that all entries on this application, including attachments, are true and complete. I agree and fully understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part of any employment with the Hocking County Sheriff’s Office. I understand that information on this application is subject to verification. I consent to references, former employees, and educational institutions listed to be contacted regarding this application. I authorize investigation of my background for any criminal or unlawful activity. By the submission of this document, I hereby agree that I shall execute the employer’s pre- and post-employment medical examination and drug testing consent forms. I recognize that my future employment with the employer will be jeopardized if I engage in substance abuse, illegal drug use, or alcohol abuse. I acknowledge that the completion of this application does not guarantee my employment but only consideration for the position(s) stated herein.

I have read and agree to the certification above.

Applicant’s name (typed signature)

Date

Additional information (use this space for anything that needed more room above)

Each application requires an original signature and current date. Unsigned applications will be destroyed and discarded. Electronically submitted applications may be signed at the time of interview.

Email the completed application to lbickel@hocking.oh.gov or mail it to HR Officer, 25 East Second Street, Logan, Ohio 43138. Questions? Call (740) 385-2131.