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Employment Application

PLEASE NOTE: It is important that you complete all parts of the application. If your application is incomplete or does not clearly show the experience and/or training required, your application may not be accepted. If you have no information to enter in a section, please enter N/A. Apply online or download, complete and return your application to:

Village of Middlefield
Attn: Employment Applications
14860 North State Ave.
Middlefield, Ohio 44062

Pre-application question(s)? Send the Village a note.

Name and Address
Name*
First Middle Last
Mailing Address*
Street Address Unit / Apartment City State ZIP Code
Social Security Number*
Telephone*
Alternate Phone (Cell)*
If under 18, please list age*
Email*
Enter Email Confirm Email
Job Type
Days/hours available to work:*
- Select All
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Sunday
I am seeking a:*
- Full-time job
- Part-time job
- Full- or part-time job
How many hours can you work weekly?*
Can you work nights?*
Date available to begin*
MM slash DD slash YYYY
Additional Information
Have you ever been employed by this organization in the past?*
- Yes
- No
I certify that I am a U.S. Citizen, permanent resident, or a foreign national with authorization to work in the United States.*
- Yes
- No
Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgement to a felony?*
- Yes
- No
If "yes", please explain.
Do you have a driver's license?*
- Yes
- No
Driver's license #
Issue in what state?
Have you had any accidents during the past three years?*
- Yes
- No
How many?
Have you had any moving violations during that past 3 years?*
- Yes
- No
How many?
Education
High School
School Address Years Completed Major Degree or Diploma
College or Business / Trade School
School Address Years Completed Major Degree or Diploma
Military
Have you ever been in the Armed Forces?*
- Yes
- No
Date Entered
MM slash DD slash YYYY
Discharge Date
MM slash DD slash YYYY
Are you now a member of the National Guard?*
- Yes
- No
Specialty
Work Experience
Please list ALL work experience beginning with your most recent job held.
List up to four jobs:*
Employer Address Supervisor Start Date End Date Starting Salary Final Salary Phone Number Last Job Title Reason For Leaving Job(s) Held May we contact this employer?
References
Exclude relative and former employers.
List up to four references*
Name Phone Number Circumstances of Your Acquaintance
Signed*
First Name Last Name
I certify that all answers and statements on this application are true and complete to the best of my knowledge. I understand that, should this application contain any false or misleading information, my application may be rejected or my employment with this company terminated.
Date Signed*
MM slash DD slash YYYY

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Employment Application

Name and Address

Job Type

Additional Information

Education

Military

Work Experience

References

Permits & Applications

Address & Hours

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Employer	Address	Supervisor	Start Date	End Date	Starting Salary	Final Salary	Phone Number	Last Job Title	Reason For Leaving	Job(s) Held	May we contact this employer?

School	Address	Years Completed	Major	Degree or Diploma

School	Address	Years Completed	Major	Degree or Diploma

Name	Phone Number	Circumstances of Your Acquaintance