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1. Personal Information This section is complete This section is incomplete
2. Education This section is complete This section is incomplete
3. Employment This section is complete This section is incomplete
4. Personal References This section is complete This section is incomplete
5. Certifications This section is complete This section is incomplete
6. Military Service Record This section is complete This section is incomplete
7. Verification This section is complete This section is incomplete
8. Authority for Release of Information This section is complete This section is incomplete

Personal Information

Application for Employment (Civil Service)
This application is for employment as a Full-Time Police Officer, Dispatcher, or EMT-P. This form will be used as your application for the appropriate Civil Service Examination. All portions must be completed in their entirety. Applicants must also register for the exam and pay the accompanying exam fee at the offices of the North Canton Civil Service Commission at 145 N Main Street North Canton, OH 44720. Applications must be submitted by the posted deadline.
Position for which you're applying:*
1. Police Officer (Full-time)
1. Fire/EMS (Full Time)
1. Dispatch (Full-time)
Personal Information
First Name*
Last Name*
Middle Initial
Address*
City*
State*
Zip Code*
Main Phone Number*
Alternate Phone Number
Email Address*
Driver's License Number*
Are you a citizen of the United States?*
1. Yes
2. No
On what date would you be available to start work?*
On what date would you be available to start work?
Have you previously been employed by the City of North Canton?*
1. Yes
2. No
If previously employed, when and in what capacity?
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Employment

List your three most recent employers beginning with the most recent.
Company Name*
Type of Business*
Address*
City*
State*
Zip Code*
Supervisor*
Supervisor Phone Number*
Supervisor Email*
Employment Began*
Employment Began
Employment Ended*
Employment Ended
Reson for Leaving*
Company Name
Type of Business
Address
City
State
Zip Code
Supervisor
Phone Number
Email
Emplyment began
Emplyment began
Employment Ended
Employment Ended
Reason for Leaving
Company Name
Type of Business
Address
City
State
Zip Code
Supervisor
Phone Number
Email
Employmetn Began
Employmetn Began
Employment Ended
Employment Ended
Reason for Leaving
Permission to Contact
I, the undersigned, hereby give permission to the City of North Canton to contact employers above concerning any information deemed relevant.
Electronic Signature*
Date*
Date
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Personal References

Name*
Relationship*
Phone Number*
Email Address*
Name*
Relationship*
Phone Number*
Email Address*
Name
Relationship
Phone Number
Email Address
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Certifications

Are you a certified Ohio Peace Officer?*
1. Yes
2. No
Most recent date of certification:
Most recent date of certification:
If no, and currently enrolled in a police academy what is your anticipated date of completion?
If no, and currently enrolled in a police academy what is your anticipated date of completion?
Are you a certified Ohio EMT-P?*
1. Yes
2. No
Most recent date of certification:
Most recent date of certification:
If no, and currently enrolled in a certification class what is your anticipated date of completion?
If no, and currently enrolled in a certification class what is your anticipated date of completion?
Are you a certified Ohio Firefigher II?*
1. Yes
2. No
Most Recent Date of Certification
Most Recent Date of Certification
If no, and currently enrolled in a certification class what is your anticipated date of completion?
If no, and currently enrolled in a certification class what is your anticipated date of completion?
Certifications Documents*
Please upload a copy of all applicable certifications or proof of enrollment in appropriate courses.
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Military Service Record

Are you now or have you ever been in the U.S. Armed Forces?*
1. Currently serving
2. Prior service
3. No service
If yes, what branch?
1. Army
2. Navy
3. Air Force
4. Marines
5. Coast Guard
Rank at Discharge:
Dates of Service:
From
From
To
To
Duties in service including any special training:
Military Service Exam Credit
In order to receive additional exam credit for military service applicants must send a copy of their form DD-214 or eqivalent to the Civil Service Commission by either:
Mail to 145 N Main St. North Canton, OH 44720; or
Email to CityCouncil@NorthCantonOhio.gov
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Verification

Notice to Applicants
This completed application must be accompanied by registering in-person at the Office of Civil Service at 145 N Main St., North Canton, Ohio 44720 for the appropriate Civil Service Exam. At the time of registration applicants will be asked to provide proof of U.S. citizenship (copy of birth certificate or passport) and pay the applicable registration fee.
I solemnly swear that all statements or facts given in the foregoing application with supporting documents are complete and true to the best of my knowledge and belief. I understand that, if employed, false statements on this application shall be considered sufficient cause for dismissal.
The City of North Canton is hereby authorized to make any investigation of my personal history, financials, and credit record through any investigative or credit agencies or bureaus of the City's choice.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document; 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature; and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date*
Date
By checking the box below, I authorize the North Canton Civil Service Commission to release my application information to the department with which I am seeking employment in order to be considered for part-time employment with the City of North Canton.
1. I would like to be considered for part-time employment.
Part-time employment is not covered by the Civil Service process. If a position is offered and accepted the individual will not have civil service protections.
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Authority for Release of Information

To Whom it May Concern:
I hereby authorize any investigator or duly accredited representative of the City of North Canton bearing this release, or a copy thereof, effective for the duration of the eligibility list, to obtain any information from schools, residential management agents, employers, criminal justice agencies, or individuals relating to my activities. This information may include, but is not limited to academic, residential, achievement, performance, attendee, employment related information, personal history, disciplinary, arrest and conviction records. I hereby direct you to release such information upon request to the bearer. I understand that the information released is for official use by the City of North Canton and may be disclosed to such third parties as necessary in the fulfillment of official responsibilities.
I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind or nature which may at any time result to me on account of compliance, or any attempts to comply with this authorization. Should there be any question as to the validity of this release, you may contact me as indicated below.
Printed Name*
Other Names Used
e.g. maiden name
Current Address*
City*
State*
Zip Code*
Phone Number*
Email Address*
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that: 1) your application will not be signed in the sense of a traditional paper document; 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature; and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date*
Date

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Civil Service Employment Application (Police, Fire, EMS)

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