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GENERAL

If you meet the minimum qualifications and have no disqualifiers, carefully read and complete all requested information. Make sure responses are as complete and detailed as possible.
Note that to complete this application, you will need:
- To upload a copy of your driver's license (a photo of your license is acceptable)
- To EITHER upload a copy of your OPOTA certification (our out-of-state equivalent) OR provide the OPOTA certification number (or out-of-state equivalent).
Note that if you only provide the certification number, you will be required to provide us a copy of your certification at a later stage in the hiring process.
All information on the application is subject to verification through an interview, background investigation or a reference check. Submission of false information is sufficient grounds for disqualification from the eligibility list and/or from appointment.
Position(s) applied for:*
Date of Application*
Date of Application
Name*
Email*
Address*
Include street address, city, state, and zip
Phone*
If necessary, best time to call you at home*
May We Contact You at Work*
1. Yes
1. No
Work Phone
Best time to call
Date Available for Work
Date Available for Work
Are you on a lay-off and subject to recall?
1. Yes
1. No
Have you filed an application here before?*
1. Yes
1. No
If yes, give dates
Positions applied for:
Were you referred by a City of Shaker Heights employee?*
1. Yes
1. No
If yes, what was the name of the employee?
Have you ever been employed by the City of Shaker Heights*
1. Yes
1. No
If yes, give dates
Departments worked
Do you have any relatives now employed by the City of Shaker Heights?*
1. Yes
1. No
If yes, give name, department and relationship
Are you willing to undergo a drug/nicotine test, criminal background check, and pre-employment physical if required?*
1. Yes
1. No
Are you legally eligible for employment in this country? (Proof of U.S. citizenship or immigration status will be required upon employment.)*
1. Yes
1. No
Can you perform the essential functions of the position(s) for which you are applying, with or without reasonable accommodation?*
1. Yes
2. No
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential tasks.
Have you ever been terminated or forced to resign from any position on the basis of unsatisfactory conduct or performance?*
1. Yes
1. No
If yes, please give more details
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EDUCATIONAL BACKGROUND

High School
Location (city, state)
Diploma / Degree*
1. Yes
2. No
Did you receive a high school equivalency diploma?
1. Yes
2. No
Date of Issue
Number
Granting Agency
Please list below other education (i.e. trade/technical school, college/university, graduate, etc.)
1. School Name
Location (city, state)
Year(s) attended
Major area of study
Certificate, diploma, or degree earned
2. School Name
Location (city, state)
Year(s) attended
Major area of study
Certificate, diploma, or degree earned
3. School Name
Location (city, state)
Year(s) attended
Major area of study
Certificate, diploma, or degree earned
Please list/describe any additional education not listed above or any relevant job related training/course work, certifications/licensures, etc.
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EMPLOYMENT HISTORY

In the space provided, give a complete record of employment for not less than the past TEN YEARS, beginning with your present or most recent employment and working back. Account for all periods, including self-employment, unemployment, and service with the U.S. Armed Forces.
If additional space is needed, please use the additional information box provided at the end of this application or upload a resume in the Optional Submissions section.
1. Current or Most Recent Employer
Phone
Address (including street, city, state and zip)
Job Titles
Include if the job was part-time or full-time status.
Immediate Supervisor & Title
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Reason for Leaving
Starting Salary / Wage
Final Salary / Wage
If you are still employed here, may we contact for reference?
1. Yes
1. No
Summary of Work
Summarize the nature of the work performed and job responsibilities.
2. Employer
Phone
Address (including street, city, state and zip)
Job Titles
Include if the job was part-time or full-time status.
Immediate Supervisor & Title
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Reason for Leaving
Starting Salary / Wage
Final Salary / Wage
Summary of Work
Summarize the nature of the work performed and job responsibilities.
3. Employer
Phone
Address (including street, city, state and zip)
Job Titles
Include if the job was part-time or full-time status.
Immediate Supervisor & Title
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Reason for Leaving
Starting Salary / Wage
Final Salary / Wage
Summary of Work
Summarize the nature of the work performed and job responsibilities.
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REQUIRED DOCUMENTS

Driver's License (front)*
Upload a copy of the front of your driver's license.
Driver's License (back)*
Upload a copy of the back of your driver's license.
Did you receive your OPOTA Certification?*
1. Yes
2. No
If yes, either upload a copy or enter certification number, if available. Please note, if unavailable, this will be required further in the application process.
OPOTA Certification Form
Upload a copy of your certification.
OPOTA Certification Number
Are you/were you a police officer in another state ?
1. Yes
2. No
If yes, be sure to list any licenses, certifications or registrations in the box below.
Other Licenses, Registrations, & Certifications
List any other licenses, registrations or certifications which you possess. Also, list the State or other licensing authority for each, and the number and expiration date of the license.
OPTIONAL SUBMISSIONS
If you would like to include additional documents (i.e. resume, cover letter, certification, etc.), please do so here:
File Upload
File Upload
File Upload
File Upload
Any additional information you would like us to know.
My signature constitutes my certification that my responses are true and complete. Where an item is left blank, it is because there is no information within its scope. My signature further constitutes my authorization for the City of Shaker Heights to investigate the facts submitted; and for those with relevant information (including but not limited to, my prior employers and references) to release such information to the City of Shaker Heights.

I understand and agree that any falsification or omission, either on this form or in my responses to questions asked during the interviewing or examination process, is grounds for immediate termination of employment, no matter when the falsification or omission is discovered.

I also understand that, if hired, my employment is to be "at will" and that either I, or my employer, may terminate my employment at any time, with or without cause, unless the "at will" arrangement is modified by a written agreement signed by both me and a duly authorized officer of the City of Shaker Heights.
Signature*
1. By checking this box, I authorize my signature.
Date Signed*
Date Signed
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BACKGROUND CHECK AUTHORIZATION

Authorization to do Background Check for Release of Confidential Information & Waiver of Privacy Rights
I hereby authorize the City of Shaker Heights and its agents or employees to conduct a background check on me from any source, including, but not limited to, past employers.
The undersigned applicant, in authorizing the City to conduct such checks and searches, hereby specifically WAIVES any right to PERSONAL PRIVACY he or she might have in the above information and RELEASES the City of Shaker Heights and any person or agency from ANY LIABILITY WHATSOEVER resulting from the release of such information to the City, and review of such information by the City.
My signature below certifies that my responses on the Application for Employment are true and complete to the best of my knowledge. I understand that employment is based on completion of all pre-employment requirements and procedures which may include:
1. Interviews
2. Urine drug screen
3. Urine test for nicotine
4. Criminal conviction record check/Truth verification
5. Pre-employment physical (if applicable to the position for which you are applying)
6. Education and reference check
7. Motor vehicle record check
8. Testing (if applicable to the position for which you are applying)
9. Proof of identity and employment eligibility for work in the U.S.
10. Social media check
Compliance with the City of Shaker Heights’ Drug and Nicotine Testing Policy is a condition of employment. Therefore, all job offers are made with the understanding that prospective employees pass a drug and nicotine screening test prior to being hired.
I understand and agree that any falsification or omission, either on this form or in response to questions asked during my interview or examination process or on employment forms I subsequently complete, including I‐9 forms, shall be grounds for immediate termination, no matter when the falsification or omission is discovered.
Signature*
1. By checking this box, I authorize my signature.
Date*
Date
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EEO SURVEY

Please Note
This survey is for informational purposes only. It assists the City in completing required Equal Employment Opportunity (EEO) Reports. This sheet will be kept confidential and maintained separately from your application form; it will not be considered in the employment process.
Completion of this form is voluntary and is not a requirement for employment.
Name
Position Applied For
Gender
Describe yourself in terms of one of the following groups (select one)
Do you have a physical impairment which substantially limits a major life activity, or have a history of such impairment?
1. No
2. Yes
Signature
1. By checking this box, I authorize my signature.
Date
Date

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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