Form ADM4174 "Pre-hire Review" - Ohio

What Is Form ADM4174?

This is a legal form that was released by the Ohio Department of Administrative Services - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2017;
  • The latest edition provided by the Ohio Department of Administrative Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ADM4174 by clicking the link below or browse more documents and templates provided by the Ohio Department of Administrative Services.

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Download Form ADM4174 "Pre-hire Review" - Ohio

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State of Ohio
Pre-Hire Review
1.
All significant educational accomplishments/certifications/licensures checked and found to be satisfactory.
Yes
No
2.
Previous employment and other references checked and found to be satisfactory.
Yes
No (If no, attach explanation)
3.
Employee History Report (EHOC)/Personnel File
No record on file.
State personnel file reviewed, including personnel actions/attachments for terminations, and inquiries
made with previous employing agency(ies).
No evidence of unsatisfactory state employment.
All notations of disciplinary actions reviewed with disciplining agency:
Explanation satisfactory
Explanation unsatisfactory
4.
Drug-Free Workplace
Not applicable
Collection Date
Report Date
5.
Criminal Background Check and/or Unclassified Background Check
_ ______________ Submission Date
Results Received Date
6.
Nepotism
Applicant has completed Supplemental Nepotism Statement.
Information on Supplemental Nepotism Statement has been reviewed:
There is no conflict of interest.
There is a conflict of interest (consult with agency legal counsel).
7.
Candidate selected was among the most qualified.
Interview packet is on file in my agency's human resources office detailing all final candidates considered
and the results of such considerations.
I certify that all of the above-listed information has been checked. This applicant will start employment ____________.
Human Resources Officer Signature
Date
ADM 4174 (Revised 10/17)
State of Ohio
Pre-Hire Review
1.
All significant educational accomplishments/certifications/licensures checked and found to be satisfactory.
Yes
No
2.
Previous employment and other references checked and found to be satisfactory.
Yes
No (If no, attach explanation)
3.
Employee History Report (EHOC)/Personnel File
No record on file.
State personnel file reviewed, including personnel actions/attachments for terminations, and inquiries
made with previous employing agency(ies).
No evidence of unsatisfactory state employment.
All notations of disciplinary actions reviewed with disciplining agency:
Explanation satisfactory
Explanation unsatisfactory
4.
Drug-Free Workplace
Not applicable
Collection Date
Report Date
5.
Criminal Background Check and/or Unclassified Background Check
_ ______________ Submission Date
Results Received Date
6.
Nepotism
Applicant has completed Supplemental Nepotism Statement.
Information on Supplemental Nepotism Statement has been reviewed:
There is no conflict of interest.
There is a conflict of interest (consult with agency legal counsel).
7.
Candidate selected was among the most qualified.
Interview packet is on file in my agency's human resources office detailing all final candidates considered
and the results of such considerations.
I certify that all of the above-listed information has been checked. This applicant will start employment ____________.
Human Resources Officer Signature
Date
ADM 4174 (Revised 10/17)