OHIO UTILITIES PROTECTION SERVICE
APPLICATION FOR EMPLOYMENT

Ohio Utilities Protection Service is an equal opportunity employer. Ohio Utilities Protection Service does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status, or unfavorable discharge from military service or any other characteristic protected by law.

Please complete all required*/applicable fields.

Personal Information

Name

Date of Birth

Address

Phone Number

Are you eligible to work in the U.S.?

Yes No

Are you at least 18 years or older? (If no, you may be required to provide authorization to work.)

Yes No

Have you ever been terminated from employment or asked to resign by an employer?

Yes No

If Yes, please provide company names and details

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

Yes No

Employment Desired

Date you can start

Hourly rate/Salary desired

Position desired

Are you currently employed?

Yes No

If so, may we inquire of your present employer?

Yes No

Referral Source

How did you hear about us?

Explanation

Have you ever worked for this company before?

Yes No

Explanation

Do you know anyone who works for our company?

Yes No

If Yes, who?

Education

High School

Location of school

College or University

Location of school

Degree Received

Subjects Studied/Major

Trade, Business or Correspondence School

Lorain of School

Degree Received

Subjects Studied/Major

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain.

Employment History
Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Employed From

Employed To

Employer Name

Address

Immediate supervisor and title

Job Title

Summarize the nature of work performed and job responsibilities

Reason for leaving

Employed From

Employed To

Employer Name

Address

Immediate supervisor and title

Job Title

Summarize the nature of work performed and job responsibilities

Reason for leaving

Employed From

Employed To

Employer Name

Address

Immediate supervisor and title

Job Title

Summarize the nature of work performed and job responsibilities

Reason for leaving

References
Give the names of three persons not related to you, whom you have known at least three (3) years.

Name

Address

Phone

Company

Years Acquainted

Name

Address

Phone

Company

Years Acquainted

Name

Address

Phone

Company

Years Acquainted

Please read carefully before submitting

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Ohio Utilities Protection Service to hire me. If I am hired, I understand that either Ohio Utilities Protection Service or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Ohio Utilities Protection Service has the authority to make any assurance to the contrary.

I accept that I have given to Ohio Utilities Protection Service true and complete information on this application. No requested information has been concealed. I authorize Ohio Utilities Protection Service to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

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