Village of Columbus Grove, Ohio, Job Application
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Indicates that this field must be filled in. )
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Name:
( Last, First & Middle Initial )
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Address:
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City:
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State:
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Zip:
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Phone Number:
( 000-000-0000 )
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Date of Birth:
( 00/00/0000 )
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Social Security Number:
( 000-00-0000 )
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Type of License:
Select One
Drivers License
CDL
Moped License
None
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Type of Position:
Select One
Street Dept.
Water Dept.
Seasonal Help
Pool Director
Head Lifeguard
Lifeguard
Concession
Any Position
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High School:
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Last Grade Completed:
College:
Years Completed:
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Tell Us About Yourself:
Name, Address, and Phone #, of Last Three (3) Places of Employment
1) Name:
Address:
Phone #:
2) Name:
Address:
Phone #:
3) Name:
Address:
Phone #:
Three (3) References, Other Than Family
1) Name:
Address:
Phone #:
2) Name:
Address:
Phone #:
3) Name:
Address:
Phone #:
Acknowledgement
I hereby acknowledge that all facts stated on this application are true and correct to the best of my knowledge.
E-mail Address:
*
I (Your Name)
agree to the acknowledgement above.
Name of parent/guardian if minor:
( Last, First & Middle Initial )