Job Application Form-Ruzzo Justice Center

Edward J Ruzzo Juvenile Justice Center North Central Ohio Rehabilitation Center (NCORC) Job Application 1440 Mt Vernon Ave Marion, Ohio 43302 Phone: 740-386-2232 or Email: jobs@ncorc.net NOTE: To be considered for employment, you must fill in the information below, accurately and completely You must also submit a resume in addition to completing this application If you need additional space, attach extra sheets to this application All applicants must be at least 21 years old in order to apply POSITION:       PREFERENCE: DATE OF APPLICATION:       1ST 2ND Fulltime 3RD Part-time PLEASE TYPE OR PRINT IN INK NAME: (Last, First, Middle) DATE OF BIRTH – Year Not Required       Month       Day       ADDRESS: (Street, City, State, Zip Code) SOCIAL SECURITY NUMBER:             HOME PHONE: ALTERNATE PHONE: EMAIL ADDRESS:                   DRIVER’S LICENSE NUMBER:       LEGAL RIGHT TO WORK IN THE U.S.: YES NO STATE:       CLASS:       HIGH SCHOOL NAME:       DID YOU GRADUATE? YES NO COLLEGE / UNIVERSITY:       DID YOU GRADUATE? YES NO YES NO EDUCATION LOCATION: (City, State)       OBTAINED GED? YES NO LOCATION: (City, State)       CHECK YEARS COMPLETED DEGREE RECEIVED:       COLLEGE / UNIVERSITY:       DID YOU GRADUATE? YES NO LOCATION: (City, State)       CHECK YEARS COMPLETED DEGREE RECEIVED:       CERTIFICATES AND LICENSES TYPE:       LICENSE NUMBER:       ISSUING AGENCY:       CERTIFICATES AND LICENSES (Continued) TYPE:       LICENSE NUMBER:       ISSUING AGENCY:       EMPLOYMENT HISTORY Please list your work experience beginning with your most recent employment Military experience and volunteer (internship) work may also be included as employment DATES: EMPLOYER: From:       To:             ADDRESS: (Street, City, State, Zip Code)       COMPANY URL: PHONE NUMBER:             DUTIES:       POSTION TITLE:       SUPERVISOR:       REASON FOR LEAVING:       DATES: EMPLOYER: From:       To:             ADDRESS: (Street, City, State, Zip Code)       COMPANY URL: PHONE NUMBER:             DUTIES:       POSTION TITLE:       SUPERVISOR:       REASON FOR LEAVING:       DATES: EMPLOYER: From:       To:             ADDRESS: (Street, City, State, Zip Code)       COMPANY URL: PHONE NUMBER:             DUTIES:       REASON FOR LEAVING:       POSTION TITLE:       SUPERVISOR:       EMPLOYMENT HISTORY (Continued) DATES: EMPLOYER: POSTION TITLE: From:       To:                   ADDRESS: (Street, City, State, Zip Code)       COMPANY URL: PHONE NUMBER: SUPERVISOR:                   DUTIES:       REASON FOR LEAVING:       The purpose of the following question is to obtain information relevant to employment with NCORC A Response is required SUMMARY OF QUALIFICATIONS – In this area below, briefly describe the experience, education, training and other factors that qualify you for the position for which you are applying If you need additional space, attach an extra sheet to this application:       NOTICE: Inquiries during the interview process will be conducted to determine if any conviction(s) have occurred that would disqualify the applicant under Ohio or Federal Law from employment to the position applied for on this Job Application I certify that the answers I have made to all of the questions in this application are true and complete to the best of my knowledge I understand that if this application is not completed in its entirety, it will not be processed and I will be automatically disqualified I understand that I am responsible for the correctness of this application I also understand that a background check is required prior to employment and that, in accordance with the Drug-Free Workplace Program, drug testing is required I waive all provisions of law forbidding colleges or universities which I attended, or past employers, from disclosing any information which they acquired relevant to my employment I consent that they may disclose such information to NCORC that holds the vacancy for which I am applying Signature of applicant: Date       ... on this Job Application I certify that the answers I have made to all of the questions in this application are true and complete to the best of my knowledge I understand that if this application. .. position for which you are applying If you need additional space, attach an extra sheet to this application:       NOTICE: Inquiries during the interview process will be conducted to determine... will be automatically disqualified I understand that I am responsible for the correctness of this application I also understand that a background check is required prior to employment and that,