Form GEN-4268 "Ohio Civil Service Application" - Ohio

What Is Form GEN-4268?

This is a legal form that was released by the Ohio Department of Public Safety - 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 June 1, 2008;
  • The latest edition provided by the Ohio Department of Public Safety;
  • 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 fillable version of Form GEN-4268 by clicking the link below or browse more documents and templates provided by the Ohio Department of Public Safety.

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Download Form GEN-4268 "Ohio Civil Service Application" - Ohio

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Ohio Civil Service Application
for State and County Agencies
GEN-4268 (REVISED 06/08)
The state of Ohio is an Equal Opportunity Employer and provider of ADA services.
POSITION:
AGENCY:
POSITION NUMBER:
P
O
I S
T
I
O
N
:
D
E
P
A
R
T
M
E
N
: T
Please submit one application per position or examination to the address indicated on the job posting or examination announcement.
ALACHUA COUNTY EMPLOYMENT APPLICATION
or postmarked by the closing date, as required by the hiring agency. Please be sure to complete the entire application. Also note that,
once submitted to a governmental agency, this completed form will be subject to all applicable public records laws.
It is important that you answer all questions on this application fully, as failure to do so may delay consideration for
employment or result in loss of employment opportunities. If an item does not apply to you, write NA (not applicable).
PLEASE TYPE OR PRINT IN INK
PLEASE TYPE OR PRINT IN INK
DATE OF BIRTH - Year Not Required
NAME: (Last, First, Middle)
Month
Day
ADDRESS: (Street, City, State, ZIP Code)
ADDRESS: (Street, City, State, Zip Code)
H
O
M
E
P
H
O
N
: E
A
L
T
E
R
N
A
T
E
P
H
O
N
: E
E
E-MAIL ADDRESS:
M
A
I
L
A
D
D
R
E
S
: S
DRIVER’S LICENSE NUMBER:
LEGAL RIGHT TO WORK IN
Yes
No
STATE:
CLASS:
THE U. S.:
Yes
No
PREFERENCES
P
R
E
F
E
R
R
E
D
S
A
L
A
R
Y
:
A
R
E
Y
O
U
W
I
L
L
I
N
G
T
O
R
E
L
O
C
A
T
E
?
Yes
No
Maybe
WHAT TYPE OF JOB ARE YOU LOOKING FOR?
TYPES OF WORK YOU WILL ACCEPT:
Regular
Temporary
Full-Time
Part-Time
SHIFTS YOU WILL ACCEPT:
Day
Evening
Night
Rotating
Weekends
On Call (as needed)
EDUCATION
H
I
G
H
S
C
H
O
O
L
N
A
M
: E
LOCATION: (City, State)
L
O
C
A
T
I
O
N
:
(
C
t i
, y
t S
t a
) e
£
£
Yes
No
DID YOU GRADUATE?
OBTAINED GED?
CHECK YEAR COMPLETED:
9
10
11
12
DID YOU GRADUATE?
Yes
No
S
C
H
O
O
L
N
A
M
E
(
C
o
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e g
U /
n
v i
r e
i s
y t
: )
L
O
C
A
T
I
O
N
:
(
C
t i
, y
t S
t a
) e
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
D
E
G
R
E
E
R
E
C
E
I
V
E
D
:
N
U
M
B
E
R
O
F
Q
U
A
R
T
E
R
S /
E
M
E
S
T
E
R
HOURS COMPLETED:
S
C
H
O
O
L
N
A
M
E
(
C
o
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e g
U /
n
v i
r e
i s
y t
: )
L
O
C
A
T
I
O
N
:
(
C
t i
, y
t S
t a
) e
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
D
E
G
R
E
E
R
E
C
E
I
V
E
D
:
N
U
M
B
E
R
O
F
Q
U
A
R
T
E
R
S /
E
M
E
S
T
E
R
HOURS COMPLETED:
S
C
H
O
O
L
N
A
M
E
(
C
o
e l l
e g
U /
n
v i
r e
i s
y t
: )
L
O
C
A
T
I
O
N
:
(
C
t i
, y
t S
t a
) e
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
D
E
G
R
E
E
R
E
C
E
I
V
E
D
:
N
U
M
B
E
R
O
F
Q
U
A
R
T
E
R
S /
E
M
E
S
T
E
R
HOURS COMPLETED:
1
Ohio Civil Service Application
for State and County Agencies
GEN-4268 (REVISED 06/08)
The state of Ohio is an Equal Opportunity Employer and provider of ADA services.
POSITION:
AGENCY:
POSITION NUMBER:
P
O
I S
T
I
O
N
:
D
E
P
A
R
T
M
E
N
: T
Please submit one application per position or examination to the address indicated on the job posting or examination announcement.
ALACHUA COUNTY EMPLOYMENT APPLICATION
or postmarked by the closing date, as required by the hiring agency. Please be sure to complete the entire application. Also note that,
once submitted to a governmental agency, this completed form will be subject to all applicable public records laws.
It is important that you answer all questions on this application fully, as failure to do so may delay consideration for
employment or result in loss of employment opportunities. If an item does not apply to you, write NA (not applicable).
PLEASE TYPE OR PRINT IN INK
PLEASE TYPE OR PRINT IN INK
DATE OF BIRTH - Year Not Required
NAME: (Last, First, Middle)
Month
Day
ADDRESS: (Street, City, State, ZIP Code)
ADDRESS: (Street, City, State, Zip Code)
H
O
M
E
P
H
O
N
: E
A
L
T
E
R
N
A
T
E
P
H
O
N
: E
E
E-MAIL ADDRESS:
M
A
I
L
A
D
D
R
E
S
: S
DRIVER’S LICENSE NUMBER:
LEGAL RIGHT TO WORK IN
Yes
No
STATE:
CLASS:
THE U. S.:
Yes
No
PREFERENCES
P
R
E
F
E
R
R
E
D
S
A
L
A
R
Y
:
A
R
E
Y
O
U
W
I
L
L
I
N
G
T
O
R
E
L
O
C
A
T
E
?
Yes
No
Maybe
WHAT TYPE OF JOB ARE YOU LOOKING FOR?
TYPES OF WORK YOU WILL ACCEPT:
Regular
Temporary
Full-Time
Part-Time
SHIFTS YOU WILL ACCEPT:
Day
Evening
Night
Rotating
Weekends
On Call (as needed)
EDUCATION
H
I
G
H
S
C
H
O
O
L
N
A
M
: E
LOCATION: (City, State)
L
O
C
A
T
I
O
N
:
(
C
t i
, y
t S
t a
) e
£
£
Yes
No
DID YOU GRADUATE?
OBTAINED GED?
CHECK YEAR COMPLETED:
9
10
11
12
DID YOU GRADUATE?
Yes
No
S
C
H
O
O
L
N
A
M
E
(
C
o
e l l
e g
U /
n
v i
r e
i s
y t
: )
L
O
C
A
T
I
O
N
:
(
C
t i
, y
t S
t a
) e
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
D
E
G
R
E
E
R
E
C
E
I
V
E
D
:
N
U
M
B
E
R
O
F
Q
U
A
R
T
E
R
S /
E
M
E
S
T
E
R
HOURS COMPLETED:
S
C
H
O
O
L
N
A
M
E
(
C
o
e l l
e g
U /
n
v i
r e
i s
y t
: )
L
O
C
A
T
I
O
N
:
(
C
t i
, y
t S
t a
) e
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
D
E
G
R
E
E
R
E
C
E
I
V
E
D
:
N
U
M
B
E
R
O
F
Q
U
A
R
T
E
R
S /
E
M
E
S
T
E
R
HOURS COMPLETED:
S
C
H
O
O
L
N
A
M
E
(
C
o
e l l
e g
U /
n
v i
r e
i s
y t
: )
L
O
C
A
T
I
O
N
:
(
C
t i
, y
t S
t a
) e
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
D
E
G
R
E
E
R
E
C
E
I
V
E
D
:
N
U
M
B
E
R
O
F
Q
U
A
R
T
E
R
S /
E
M
E
S
T
E
R
HOURS COMPLETED:
1
EMPLOYMENT HISTORY
Please list your work experience beginning with your most recent employment. Military experience and volunteer work may also
be included as employment. NOTE:
completely. You may submit a résumé in addition to completing this section. If applying for a civil service examination, only the
information provided below will be considered. A résumé may not be used. If you need additional space, attach extra sheets to
this application.
ADDRESS: (Street, City, State, ZIP Code)
ADDRESS: (Street, City, State, ZIP Code)
ADDRESS: (Street, City, State, ZIP Code)
2
EMPLOYMENT HISTORY (Continued)
ADDRESS: (Street, City, State, ZIP Code)
ADDRESS: (Street, City, State, ZIP Code)
SKILLS
OFFICE SKILLS:
Typing Speed:
Data Entry Speed:
COMPUTER SKILLS:
OTHER SKILLS:
LANGUAGE(S):
3
The purpose of questions 1-9 is to obtain information relevant to employment with the state of Ohio. Responses to these questions
are required.
1. SUMMARY OF QUALIFICATIONS-
qualify you for the position or examination for which you are applying. Refer to the
and any position-spe-
posted for this position or examination. If you need additional space, attach an extra sheet to this application.
you are applying. Also indicate the number of courses you have successfully completed in each area. NOTE: A transcript may not
be substituted for this section, although you may be required to submit a transcript.
3. Are you a current state of Ohio employee?
___Yes
___No
4. If you are a current state of Ohio employee, please provide your Employee ID number. If you are not a current state of Ohio
employee, please indicate N/A.
________________________
5. If you are not a current state of Ohio employee, have you ever been employed by the state of Ohio? (If you are a current state of
Ohio employee, please select N/A.)
___ Yes
___ No
___N/A
6. If you were previously employed by the state of Ohio, please choose one of the following:
___ Employment ended prior to 12-01-2004.
___ Employment ended on or after 12-01-2004.
___ N/A - Not previously employed by the state of Ohio or current state employee.
7. Have you ever been convicted of a felony? (A felony conviction may not automatically exclude you from consideration.)
___ Yes
___No
8. If you answered Yes to the previous question, please give date(s) of conviction(s) and explain. If you answered No, please indicate N/A.
9. How did you learn about this employment or examination opportunity?
___ careers.ohio.gov
___ Monster.com
___ Trade journal
___ Walk-in
___ Ohiomeansjobs.com
___ Other Internet Web site
___ State of Ohio Employee Referral
___ Other
___ GovernmentJobs.com
___ Newspaper
___ Civil Service test announcement
CERTIFICATION
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 applica-
application. I also understand that a background check may be required prior to employment and that, in accordance with the Drug-Free Workplace Program, drug
testing may be 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 the Human Resources Division, Ohio Department of Administra-
employment is conditional upon proof of legal authorization to work in the United State as required by the Immigration Reform and Control Act.
Signature of Applicant_______________________________________________________ Date___________________________
4
STATE OF OHIO
EQUAL EMPLOYMENT OPPORTUNITY
Responses to questions 10-15 are OPTIONAL. These questions are included to assist our equal employment opportunity efforts.
Providing this information is VOLUNTARY and will in no way affect the processing of your application or your being considered for
employment. Human Resources will process your responses to these confidential questions separately. Responses will be used for
statistical purposes only.
Position Applied For _________________________________
Date_______________________________
Agency ____________________________________________
Position Number_____________________
10. OPTIONAL: Sex
___Male
___Female
11. OPTIONAL: Please select your age group.
___ Under 18
___ 18-25
___ 26-39
___ 40-54
___ 55-69
___ 70+
12. OPTIONAL: Race/Ethnicity
___
WHITE: All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
___
BLACK or AFRICAN AMERICAN: All persons having origins in any of the Black racial groups of Africa.
___
HISPANIC or LATINO: All persons of Mexican, Puerto Rican, Cuban, Central or South America or other Spanish
culture or origin, regardless of race.
___
ASIAN: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian
Subcontinent (for example, China, India, Japan and Korea).
___
NATIVE HAWAIIAN or PACIFIC ISLANDER: All persons having origins in any of the original peoples of the
Hawaiian Islands and Pacific Islands (for example, Hawaii, Philippine Islands and Samoa).
___
AMERICAN INDIAN or ALASKAN NATIVE: All persons having origins in any of the original peoples of North
America and who maintain cultural identification through tribal affiliation or community recognition.
___
OTHER: Please self define. ______________________________
13. OPTIONAL: Are you an individual with a physical or mental impairment which substantially limits one or more of your major
life activities?
___Yes
___No
14. OPTIONAL: Are you a veteran?
___Yes
___No
15. OPTIONAL: If you answered Yes to the previous question, please indicate if one or more of the following apply.
___
MILITARY STATUS: The performance of duty in a uniformed service, to include active duty, active duty for
training, initial active duty for training, inactive duty for training, full-time National Guard duty.
___
DISABLED VETERAN: A person whose discharge or release from active duty was for a disability incurred or
aggravated in the line of duty.
___
DESERT STORM/SHIELD VETERAN: A person whose active duty was performed after August 2, 1990, in the
Persian Gulf Conflict.
___
VIETNAM ERA VETERAN: A person served on active duty for a period of more than 180 days, any part of which
occurred between August 5, 1964, and May 7, 1975.
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