Form GEN-4268 "Ohio Civil Service Application for State and County Agencies" - Ohio

What Is Form GEN-4268?

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 March 1, 2016;
  • 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 fillable version of Form GEN-4268 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 GEN-4268 "Ohio Civil Service Application for State and County Agencies" - Ohio

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Ohio Civil Service Application
for State and County Agencies
GEN-4268 (REVISED 3/16)
The State of Ohio Is an Equal Opportunity Employer and provider of ADA services.
POSITION:
AGENCY:
POSITION NUMBER:
Please submit one application per position or examination to the address indicated on the job posting or examination announcement. Copies
are acceptable. Applications lacking sufficient information will not be processed. Please ensure your application is received 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.
PLEASE TYPE OR PRINT IN INK
NAME: (Last, First, Middle)
DATE OF BIRTH - Year Not Required
Month
Day
ADDRESS: (Street, City, State, ZIP Code)
HOME PHONE:
ALTERNATE PHONE:
E-MAIL ADDRESS:
LEGAL RIGHT TO WORK IN THE U.S.:
DRIVER'S LICENSE:
(Optional)
Yes
No
Yes
No
PREFERENCES
PREFERRED SALARY:
ARE YOU WILLING TO RELOCATE?
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
HIGH SCHOOL NAME:
LOCATION: (City, State)
DID YOU GRADUATE?
Yes
No
CHECK YEAR COMPLETED:
OBTAINED GED?
9
10
11
12
Yes
No
SCHOOL NAME: (College/University)
LOCATION: (City, State)
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
DEGREE RECEIVED:
NUMBER OF QUARTER/SEMESTER HOURS
COMPLETED:
SCHOOL NAME: (College/University)
LOCATION: (City, State)
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
DEGREE RECEIVED:
NUMBER OF QUARTER/SEMESTER HOURS
COMPLETED:
SCHOOL NAME: (College/University)
LOCATION: (City, State)
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
DEGREE RECEIVED:
NUMBER OF QUARTER/SEMESTER HOURS
COMPLETED:
1
Ohio Civil Service Application
for State and County Agencies
GEN-4268 (REVISED 3/16)
The State of Ohio Is an Equal Opportunity Employer and provider of ADA services.
POSITION:
AGENCY:
POSITION NUMBER:
Please submit one application per position or examination to the address indicated on the job posting or examination announcement. Copies
are acceptable. Applications lacking sufficient information will not be processed. Please ensure your application is received 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.
PLEASE TYPE OR PRINT IN INK
NAME: (Last, First, Middle)
DATE OF BIRTH - Year Not Required
Month
Day
ADDRESS: (Street, City, State, ZIP Code)
HOME PHONE:
ALTERNATE PHONE:
E-MAIL ADDRESS:
LEGAL RIGHT TO WORK IN THE U.S.:
DRIVER'S LICENSE:
(Optional)
Yes
No
Yes
No
PREFERENCES
PREFERRED SALARY:
ARE YOU WILLING TO RELOCATE?
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
HIGH SCHOOL NAME:
LOCATION: (City, State)
DID YOU GRADUATE?
Yes
No
CHECK YEAR COMPLETED:
OBTAINED GED?
9
10
11
12
Yes
No
SCHOOL NAME: (College/University)
LOCATION: (City, State)
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
DEGREE RECEIVED:
NUMBER OF QUARTER/SEMESTER HOURS
COMPLETED:
SCHOOL NAME: (College/University)
LOCATION: (City, State)
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
DEGREE RECEIVED:
NUMBER OF QUARTER/SEMESTER HOURS
COMPLETED:
SCHOOL NAME: (College/University)
LOCATION: (City, State)
CHECK YEAR COMPLETED:
DID YOU GRADUATE?
MAJOR:
1
2
3
4
5
6
Yes
No
DEGREE RECEIVED:
NUMBER OF QUARTER/SEMESTER 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: To be considered for employment, you must fill in the information below, accurately and completely. You may
submit a resume in addition to completing this section. If applying for a civil service examination, only the information provided below will
be considered. A resume may not be used. If you need additional space, attach extra sheets to this application.
DATES:
EMPLOYER:
POSITION TITLE:
From:
To:
ADDRESS: (Street, City, ZIP Code)
COMPANY URL:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
SALARY:
MAY WE CONTACT THIS EMPLOYER:
Yes
No
DUTIES:
REASON FOR LEAVING:
DATES:
EMPLOYER:
POSITION TITLE:
From:
To:
ADDRESS: (Street, City, ZIP Code)
COMPANY URL:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
SALARY:
MAY WE CONTACT THIS EMPLOYER:
Yes
No
DUTIES:
REASON FOR LEAVING:
DATES:
EMPLOYER:
POSITION TITLE:
From:
To:
ADDRESS: (Street, City, ZIP Code)
COMPANY URL:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
SALARY:
MAY WE CONTACT THIS EMPLOYER:
Yes
No
DUTIES:
REASON FOR LEAVING:
2
EMPLOYMENT HISTORY (Continued)
DATES:
EMPLOYER:
POSITION TITLE:
From:
To:
ADDRESS: (Street, City, ZIP Code)
COMPANY URL:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
SALARY:
MAY WE CONTACT THIS EMPLOYER:
Yes
No
DUTIES:
REASON FOR LEAVING:
DATES:
EMPLOYER:
POSITION TITLE:
From:
To:
ADDRESS: (Street, City, ZIP Code)
COMPANY URL:
PHONE NUMBER:
SUPERVISOR:
HOURS PER WEEK:
SALARY:
MAY WE CONTACT THIS EMPLOYER:
Yes
No
DUTIES:
REASON FOR LEAVING:
CERTIFICATES AND LICENSES
TYPE:
LICENSE NUMBER:
ISSUING AGENCY:
TYPE:
LICENSE NUMBER:
ISSUING AGENCY:
SKILLS
OFFICE SKILLS:
Typing Speed:
Data Entry Speed:
COMPUTER SKILLS:
OTHER SKILLS:
LANGUAGE(S):
3
The purpose of questions 1-8 is to obtain information relevant to employment with the State of Ohio.
Responses to these questions are required.
1. Please indicate your county of residence.
2. Summary of Qualifications - In the area below, briefly describe the experience, education, training and other factors that qualify you for the position or
examination for which you are applying. Refer to the Minimum Qualifications and any position-specific qualifications posted for this position or examination.
If you need additional space, attach an extra sheet to this application.
3. Please list below the specific course work areas at the high school level or beyond relevant to the position or examination for which 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.
4. Are you a current State of Ohio employee?
Yes, I'm a permanent employee
Yes, I'm an interim or intermittent employee
Yes, I'm a temporary, seasonal or project employee
Yes, I'm a fixed term or established term employee
No, I'm not a State of Ohio employee
5. If you are a current State of Ohio employee, please provide your eight (8) digit, OAKS ID number. If you are not a current State of Ohio employee, please
type N/A.
6. 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
7. 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 12-02-2004.
N/A - Not previously employed by the State of Ohio or current state employee.
8. How did you learn about this employment opportunity?
careers.ohio.gov
Facebook
Trade Journal
GovernmentJobs.com
Twitter
Career/Recruitment Fair
Indeed.com
Linkedin
State of Ohio Employee Referral
Other Job Board
Other Social Media
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 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 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 Administrative Services, and/or the agency that holds the vacancy for which I am applying and to
appropriate officials for recruitment purposes. I understand that any offer of employment is conditional upon proof of legal authorization to work in the
United States as required by the Immigration Reform and Control Act.
Signature of Applicant:
Date:
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