Application for Treasurer

Personal Information
Name First Middle Last
Address
Street Address

Address Line 2

State

City

Postal / Zip Code
Social Security Number
Home Phone - (###) - ### ####
Work Phone - (###) - ### ####
Cell Phone - (###) - ### ####
Email
Are You currently under contract to another district? Yes No
If yes, when does the contract expire? / MM / DD YYYY
Date available for employment? / MM / DD YYYY
Current base salary (Not including fringe benefits) $ Dollars
Base salary expectations? (Not including fringe benefits) $ Dollars
Do you hold a valid Ohio Treasurer's Certificate or Licence? Yes No
Type of Certificate? City Local Other
Other (Indicate)
Certificate Number?
Have you ever been convicted of a felony? Yes No
If yes, please explain.
Note: Candidates Are subject to a criminal background check.