5270 US - 22Morrow, OH45152
5270 E US RT 22 Morrow, Ohio 45152 (513) 899-2222
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital, veteran status, sexual orientation, or any other legally protected status.
Last Name: Last Name:
First Name: First Name:
Middle Name: Middle Name:
Address: Address:
City: City:
State: Select StateAL - AlabamaAK - AlaskaAZ - ArizonaAR - ArkansasCA - CaliforniaCO - ColoradoCT - ConnecticutDE - DelawareDC - District Of ColumbiaFL - FloridaGA - GeorgiaHI - HawaiiID - IdahoIL - IllinoisIN - IndianaIA - IowaKS - KansasKY - KentuckyLA - LouisianaME - MaineMD - MarylandMA - MassachusettsMI - MichiganMN - MinnesotaMS - MississippiMO - MissouriMT - MontanaNE - NebraskaNV - NevadaNH - New HampshireNJ - New JerseyNM - New MexicoNY - New YorkNC - North CarolinaND - North DakotaOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaPR - Puerto RicoRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVT - VermontVA - VirginiaWA - WashingtonWV - West VirginiaWI - WisconsinWY - Wyoming
Zip Code: Zip Code:
Home Telephone Number: Home Telephone Number
Work Telephone Number: Work Telephone Number
Position You Are Applying For: Position You Are Applying For:
Have You Applied For A Position With Us Before? Have You Applied For A Position With Us Before?: no yes
When And For What Position: When And For What Position:
Have You Been Employed By Us Before? Have You Been Employed By Us Before?: no yes
When And What Position: When And What Position:
Are You Currently Employed? Are You Currently Employed?: no yes
Present Employer: Present Employer:
Present Employer's Phone Number: Present Employer's Phone Number
May We Contact Them For Reference? May We Contact Them For Reference?: no yes
Are You Prevented From Becoming Employed Because of Visa or Immigration Status? Are You Prevented From Becoming Employed Because of Visa or Immigration Status?: no yes
(Proof of citizenship or immigration status will be required upon employment.)
On What Date Would You Be Available For Work?: On What Date Would You Be Available For Work?
Are You Available To Work Are You Available To Work: Full Time Part Time Volunteer (Fire & EMS Only)
Are You Currently On "Lay-Off" Status and Subject To Recall? Are You Currently On "Lay-Off" Status and Subject To Recall?: no yes
Certain felony and misdemeanor convictions may disqualify an individual from employment for position of fire fighter, EMT, and road department.
School Name: School Name:
School Address: School Address:
Years Completed: Years Completed:
Diploma/Degree: Diploma/Degree:
Describe Specialized Training, Apprentice, Skills & Extra-Curricular Activities: Describe Specialized Training, Apprentice, Skills & Extra-Curricular Activities
Decribe Any Job-Related Training Received in the United States Military: Decribe Any Job-Related Training Received in the United States Military
Do You Have A Valid Ohio Driver License? Do You Have A Valid Ohio Driver License?: no yes
License #: License #:
Do You Have A Commercial Driver License (CDL)? Do You Have A Commercial Driver License (CDL)?: no yes
Class(es): Class(es):
Endorsement(s): Endorsement(s):
Have You Ever Been Convicted of a Traffic Violation? Have You Ever Been Convicted of a Traffic Violation?: no yes
If So, When and Disposition of Case: If So, When and Disposition of Case:
Start with your present of last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.
Employer: Employer:
From: From
To: To
Phone: Phone
Position and Description of Work Performed: Position and Description of Work Performed
Reason For Leaving: Reason For Leaving:
List Professional, Trade, Business, or Civic Activities and Offices Held: List Professional, Trade, Business, or Civic Activities and Offices Held
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status.
Summarize special job-related skills and qualifications acquired from employment or other experience. Also indicate any licensure or certification(s) that you possess that may be applicable to the position for which you are applying:
Other Qualifications/Licensure/Certifications: Other Qualifications/Licensure/Certifications
Please List Any Skills/Qualifications That Would Fit the Fire/EMS Department: Please List Any Skills/Qualifications That Would Fit the Fire/EMS Department
List All Fire/EMS Training/Certifications: List All Fire/EMS Training/Certifications
Note to the applicant: Do NOT answer the following question unless you have been given a copy of the job description and understand the requirements for the position for which you are applying.
Are You Capable of Performing the Activities in the Job That You Applied For? Are You Capable of Performing the Activities in the Job That You Applied For?: no yes
Name: Name:
Relationship: Relationship:
Include copies of the following documents/informtion. Upload them by clicking the 'SELECT FILE' button below:
Include copies of the following documents/cards if you have them. Upload them by clicking the 'SELECT FILE' button below:
All part-time applicants must be a minimum firefighter 1 and EMT-Basic certified. Volunteer applicants should attach any current applicable certifications. Upload them by clicking the 'SELECT FILE' button below.
If you have any questions feel free to contact us at (513) 899-2222.
File Upload: Select file (doc, docx, pdf, txt) max: 4mb
Post-Job Offer Medical Examination and Pre-Employment and Post-Employment Drug/Alcohol Testing Consent Form
THE APPLICANT UNDERSTANDS AND ACKNOWLEDGES THAT SALEM TOWNSHIP (EMPLOYER) RESERVES THE RIGHT TO REQUIRE THE APPLICANT TO SUBMIT TO ANY REQUESTED MEDICAL EXAMINATION(S) AFTER A JOB OFFER HAS BEEN MADE AND PRIOR TO THE APPLICANT’S FIRST DAY OF EMPLOYMENT. SUCH EXAMINATION(S) WILL BE PERFORMED BY A LICENSED PHYSICIAN OR MEDICAL PRACTITIONER OF THE EMPLOYER’S CHOOSING. FURTHERMORE, THE APPLICANT IS SUBJECT TO A PRE-EMPLOYMENT TEST FOR ILLEGAL DRUG USE OR SUBSTANCE ABUSE. IF THE APPLICANT FAILS ANY OF THE REQUIRED PRE-EMPLOYMENT TESTS RELATING TO DRUG OR SUBSTANCE USE OR ABUSE, OR IS OTHERWISE FOUND TO BE PHYSICALLY INCAPABLE OF PERFORMING THE JOB FOR WHICH HE/SHE IS APPLYING, THE APPLICATION PROCEDURE WILL BE TERMINATED, AND THE APPLICANT WILL NOT BE EMPLOYED. IN ADDITION TO DRUG TESTING PRIOR TO EMPLOYMENT, THE EMPLOYER RESERVES THE RIGHT TO PERFORM, AND THE APPLICANT WAIVES ANY RIGHT TO OBJECT TO, MANDATORY URINALYSIS TO DETECT ALCOHOL ABUSE, ILLEGAL DRUG ABUSE, OR SUBSTANCE ABUSE, AFTER THE APPLICANT BECOMES EMPLOYED BY THE EMPLOYER, SHOULD THE EMPLOYER REASONABLY SUSPECT SAID EMPLOYEE IS UNDER THE INFLUENCE OF ALCOHOL OR ILLEGAL DRUGS WHILE ON DUTY AT THE EMPLOYER’S WORK PLACE. IN ADDITION, ANY EMPLOYEE WHO IS REQUIRED TO POSSESS A COMMERCIAL DRIVER LICENSE TO PERFORM THE ESSENTIAL FUNCTION OF HIS/HER POSITION WILL ALSO BE REQUIRED TO SUBMIT TO ALCOHOL/DRUG TESTING PER SALEM TOWNSHIP’S ESTABLISHED CDL ALCOHOL AND DRUG TESTING POLICY WHICH INCLUDES TESTING AS FOLLOWS: PRE-EMPLOYMENT, RANDOM, POST ACCIDENT, REASONABLE SUSPICION, AND RETURN TO DUTY. BY SIGNING THIS DOCUMENT, THE APPLICANT CONSENTS TO SUBMIT TO THE AFOREMENTIONED TESTS AND PROCEDURES IF REQUIRED, AND AGREES THAT HE/SHE HAS NO CAUSE OF ACTION AGAINST THE EMPLOYER ARISING FROM THESE ISSUES. IF THE APPLICANT REFUSES TO CONSENT TO ANY OF SAID TESTS AND PROCEDURES, THE EMPLOYER SHALL NOT ACCEPT OR FURTHER PROCESS HIS/HER APPLICATION FOR EMPLOYMENT.
Signature of Applicant: Signature of Applicant:
Date Signed: Date Signed
I CERTIFY THAT THE ANSWERS GIVEN BY ME TO THE FOREGOING QUESTIONS AND THE STATEMENTS MADE BY ME ARE COMPLETE AND TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS OF FACTS CALLED FOR IN THIS APPLICATION MAY RESULT IN REJECTION OF MY APPLICATION OR DISCHARGE AT ANY TIME DURING MY EMPLOYMENT. I AUTHORIZE ALL PERSONS, LAW ENFORCEMENT AUTHORITIES, OR OTHER AGENCIES TO RELEASE TO SALEM TOWNSHIP INFORMATION CONCERNING MY BACKGROUND, INCLUDING ANY CRIMINAL HISTORY AND MOTOR VEHICLE DRIVING RECORDS. I RELEASE ANY SAID PERSON, SCHOOLS, COMPANIES, AND LAW ENFORCEMENT AUTHORITIES FROM ANY LIABILITY FOR ANY DAMAGE WHATSOEVER FOR ISSUING THIS INFORMATION.
