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CONTACT INFORMATION

THE BOARD OF MIAMI COUNTY COMMISSIONERS, AN EQUAL OPPORTUNITY EMPLOYER
Please type or print responses to all of the questions contained on the entire application.
POSITION TITLE
Developmental Specialist, Early Intervention Department
HOW DID YOU HEAR ABOUT THE POSITION?*
FIRST NAME*
MIDDLE INITIAL
LAST NAME*
EMAIL ADDRESS:*
HOME ADDRESS*
HOME ADDRESS (CONTINUED)
CITY*
STATE*
ZIP*
COUNTY*
BEST CONTACT NUMBER*
ARE YOU 18 YEARS OR OLDER?
1. YES
1. NO
Attach Resume
Uploading your resume is strongly encouraged, but not required. Please note that the following employment fields will not be populated from any files you may choose to upload.
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EMPLOYMENT HISTORY
In this section, list all employment history and work experience in date order, including military experience. Begin with your current employer. At the end of this application you may upload your additional work history in .pdf, .doc. or .docx format if you run out of space on this form. Failure to include all employment may be grounds for disqualification.
CURRENT EMPLOYER*
Enter "NONE" if unemployed
MAY WE CONTACT YOUR CURRENT EMPLOYER PRIOR TO EMPLOYMENT?*
1. YES
1. NO
ADDRESS
ADDRESS (CONTINUED)
CITY
STATE
ZIP
PHONE NUMBER
START DATE*
START DATE
JOB TITLE*
SUPERVISOR'S NAME
BEGINING SALARY*
CURRENT SALARY*
DESCRIBE YOUR DUTIES, RESPONSIBILITIES, EQUIPMENT OPERATED, PROMOTIONS, ETC*
WHY DO YOU WANT TO LEAVE?*
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This section is intended to give the employer information about the education and training that the applicant has completed, and to demonstrate skills, knowledge, and abilities to perform the job duties of the position.
HIGH SCHOOL ATTENDED
ADDRESS
DID YOU GRADUATE
1. YES
1. NO
HIGH SCHOOL EQUIVALENT?
COURSES PERTAINING TO JOB APPLIED FOR
ACTIVITIES, AWARDS, SPORTS, ETC
COLLEGE OR TRADE SCHOOL ATTENDED
ADDRESS
DID YOU GRADUATE?
1. YES
1. NO
DEGREE
COURSES PERTAINING TO JOB APPLIED FOR
ACTIVITIES, AWARDS, SPORTS, ETC
GRADUATE SCHOOL ATTENDED
ADDRESS
DATES OF ATTENDANCE
DATES OF ATTENDANCE Start Date
—
DATES OF ATTENDANCE End Date
DID YOU GRADUATE?
1. YES
1. NO
DEGREE
Further Information
Please use the following space to provide any further information on training, education, skills, abilities, volunteer work, etc., that you possess or have experienced that may be helpful in the evaluation of your application.
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USE THIS SECTION TO UPLOAD RESUMES, COVER LETTERS, OR ANY OTHER SUPPORTING DOCUMENTATION. THE FOLLOWING FILE TYPES ARE SUPPORTED doc. docx. pdf. jpg.
ATTACHMENT 1
ATTACHMENT 2
ATTACHMENT 3
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