Education, Certification and Training

EDUCATION, CERTIFICATION AND TRAINING

Please provide your education, certification, or vocational education. Attach an additional sheet if necessary.

Do you have a high school diploma, GED certificate, or equivalent? Yes No

NAME OF SCHOOL	LOCATION OF SCHOOL	COURSE OF STUDY	YEARS OR SEMESTER COMPLETED	DEGREE, DIPLOMA, OR CERTIFICATE EARNED

List any special skills you may have:

Do you currently have a valid driver’s license? Yes No

Driver’s License Number:

State of Issue:

Expiration Date:

Operator Commercial Driver License

Any Restrictions (Please List)

CERTIFICATION OF INFORMATION

Initial each paragraph and sign below:

_____ I hereby certify that I have not knowingly withheld or misrepresented any information pertaining to my application for employment and that the answers given are true and correct to the best of my knowledge. I understand that any omission or misstatement of material fact on this application or any document used to secure employment shall be grounds for rejection of this application or immediate discharge if I am employed, regardless of the time elapsed before discovery.

_____ I hereby authorize the City of Oakwood to thoroughly investigate any references, work record, education, and other matters related to my suitability for employment.

_____ I understand and agree that as part of the pre-employment process, I may be asked to sign a form authorizing the City of Oakwood to obtain a Consumer Report. I further understand that any offer of employment may be contingent upon the successful completion of a background check and physical exam as to my fitness for employment.

SIGN

Signature

(Typed Signature are accepted)

Date