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Please use Format (111)123-1234
Describe any instructions for emergency personnel - e.g., medical allergies, medical conditions etc. This info will be kept in the strictest confidence only to be used by the City in case of emergency and in no way affect your employment status.
See 'The Finder' at tax.ohio.gov
Please notify the exemption number you are using for your federal taxes
NOTE: If married, but legally separated, or spouse is a nonresident alien, choose the "Single" option.
For those employees 18 years and older, please review the section and state that all the info provided is correct.
I authorize and give consent for the City of Mayfield Heights to obtain information regarding myself. This includes: Local and National Criminal background records/information, All 50 Sex Offender Registry checks, Address trace, and Information Verification.
I authorize this information to be obtained either in writing or via telephone in connection with my volunteer application. Any person, firm or organization providing information or records in accordance with this authorization is released from any and all claims of liability for compliance. Such information is held in confidence in accordance with the organization's guidelines.
I acknowledge that I have been informed that the City may engage in mandatory drug testing of applicants for positions, that I support such testing, and that I voluntarily consent to such testing.
For those employees 18 years and older, Pre-Employment Drug Screening has been scheduled for May 16, 2017, at 4:00 pm at city hall. Those unable to attend on that date must appear for testing at a center designated by the City prior to the commencement of employment. Contact HR for center locations and an authorization form if you will not attend testing at city hall.
Only answer if you have answered yes to the previous question.
If none, please answer N/A
If this is an elected position or if you have been appointed to an elected position, provide the date the elective service began.
If answered yes, please provide the date of first public service
If yes, please list the previous employers
If yes, and you wish to request a determination relative to your non-contributing service, please provide OPERS with a completed Certification of Unreported Public Service (Form AA)
I have read the letter regarding the Hepatitis B vaccination
I have read and understand the Exchange Notice and Eligibility Guidelines
I have read and understand the Employee Handbook set forth by the City of Mayfield Heights
I have read and understand the specific Department Handbook set forth by each specific department i.e. Day Camp, Teen Camp, Pool
Forms in this section MUST be printed, completed and returned prior to the first day of employment.
This field is not part of the form submission.
* indicates a required field