Franklin County Engineer’s Civil Service Application

Cornell R. Robertson, P.E., P.S.— Franklin County Engineer

Franklin County is an Equal Opportunity Employer and provider of ADA services.

INSTRUCTIONS TO APPLICANTS:
Submit completed applications to: Franklin County Engineer’s Office
Attn: Human Resources
970 Dublin Road
Columbus, OH 43215
SEASONAL
Please note that applications are kept for two years from the date of receipt. It is the responsibility of the applicant to assure
that this form is received or postmarked by the closing date, as required by the hiring agency. Please be sure to complete ALL
sections of this application - those lacking sufficient information will be rejected. Also note that this completed form will become
a public record when submitted to a government agency.

PERSONAL INFORMATION
Social Security Number Last Name First Name Middle Initial
657-88-3911 Mahmood Khawaja M
Home Address (Street Number and Name) City County
1556 Fowler Drive, APT C Columbus Franklin

State Zip Code Primary Phone Secondary Phone

OH 43224 4403198701

JOB(S) APPLIED FOR

Enter below the specific titles of the job(s) for which you CHECK the type(s) of work for which you are applying:
are applying:
□ 1. Permanent full-time □ 2. Permanent part-time □ 3. Temporary full-time
□ -
4. Temporary part-time □x 5. Intern/Seasonal Help

COUNTY EMPLOYMENT
Are you currently a County employee? Have you ever been employed in state or county service in Ohio?
□ Yes □x No □ Yes □ x No

If yes, please provide Job Title and Agency If yes, please provide Job Title and Agency

________________________________________________ ________________________________________________

________________________________________________ ________________________________________________

LICENSES, REGISTRATION, AND CERTIFICATIONS

DRIVERS LICENSE:
Do you have an Ohio Driver’s License? x
□ Yes □ No

TZ623542
If yes, please provide the Number__________________ 06-21-2016
and Expiration Date__________________

If no, will you be able to secure a license if one is required? □ Yes □ No

Do you have a Commercial Driver’s License? □ Yes □x No

If YES, type A □ or type B □?

LICENSES AND CERTIFICATIONS:

License/Certification Issued By: Field/Trade/Specialization License/Certificate Number Expiration Date

Revised 01/16
EDUCATION AND TRAINING
Education
Circle highest grade completed:
1 2 3 4 5 6 7 8 9 10 11 12 GED College 1 2 3 4 Graduate School 1 2 3 4

Are you currently attending school? □ YES □ NO

In the table below, under Sem/Qtr Hrs., list the hours of credit received and if they were semester (S) or quarter (Q) hours.

Sem/ Type of
Date Attended (mo/yr) Qtr Major/Minor Degree
Schools Name and Location (city, state) From: To: Grad? Hrs. Course Work Received

Gulshan College, x
YES □
Science FSE
Karachi, Pakistan 2009-2011 NO □
High School

YES □
NO □
GED
Cuyahoga Community College, x
YES □
College/ Cleveland, OH 2013-2015 NO □ Arts and Science AA
University

Ohio State University, YES □

2015-2019 BS
College/ Columbus, OH NO □x Civil Engineering
University

YES □
Graduate or NO □
Professional

Other educational, YES □

vocational school, NO □
internships, etc.

Related training programs and seminars you have completed in the last five years (list):

If the job(s) applied for calls for specific courses, indicate courses taken and credits received:

Membership in professional, honorary, or technical societies (list):

ACI, SEAoO, ASCE, PLSO

SKILLS
List special equipment you can operate:

List computer software in which you have skill, including word processing, spreadsheet, and database programs. Please indicate the
name of the specific software:
Word,Outlook, One Note, Excel, Power-point, AutoCAD Civil 3D, SOLIDWORKS, SkyCiv,

List any special clerical skills, including typing and shorthand:

Auditing, time management, prioritization, schdeuling, data entry, spreadsheets,
book keeping, budgeting, billing, technology savy 60 wpm
Typing speed: ____________
List any additional relevant skills you have:
Customer Service, Good at communicating, Team Builder,
Team Worker.
WORK HISTORY (include volunteer and military experience) If additional space is required, you may attach extra sheets.
Note: • List SEPARATELY each job held when you worked for one employer and held more than one position.
• You must complete the work history portion of this application in order to be considered for employment. A résumé may
be submitted IN ADDITION TO the completion of this section.
• Start with current or most recent employer

Current or Last Employer: Address:

Uber

Job Title: Supervisor’s Name: Telephone Number: # of persons supervised by

Driver you:

Date Employed (mo/yr) Starting Salary Ending or Current Salary May we contact this Employer?
Jan/2016 $ per $ per

Date Separated (mo/yr) Reason for leaving

Currently working

Full Time Years Months List major duties in order of importance in the job:

Pick up and drop off

Part Time Years Months
x 3 2

If part time, average # of hours

worked per week:

Employer: Address:
Fairfield Inn and Suites 3031 Olentangy River Rd, Columbus, OH 43202

Job Title: Supervisor’s Name: Telephone Number: # of persons supervised by

Michael Ehrman you:
Night Auditor 614-267-1111

Date Employed (mo/yr) Starting Salary Ending Salary May we contact this Employer?
05/2016 $ 9.50 per hr $ 11.50 per hr Yes
Date Separated (mo/yr)
Reason for leaving : Schedule did not work out with my full time classes
09/2017
List major duties in order of importance in the job:
Full Time Years Months
x Data Entry, Auditing, Shelving documents,

Part Time Years Months

If part time, average # of hours

worked per week:

Employer: Address:

Job Title: Supervisor’s Name: Telephone Number: # of persons supervised by

you:

Date Employed (mo/yr) Starting Salary Ending Salary May we contact this Employer?
$ per $ per
Date Separated (mo/yr)
Reason for leaving

List major duties in order of importance in the job:

Full Time Years Months

Part Time Years Months

If part time, average # of hours

worked per week:
WORK HISTORY (continued)

Employer: Address:

Job Title: Supervisor’s Name: Telephone Number: # of persons supervised by

you:

Date Employed (mo/yr) Starting Salary Ending Salary May we contact this Employer?

Date Separated (mo/yr) Reason for leaving

Full Time Years Months List major duties in order of importance in the job:

Part Time Years Months

If part time, average # of hours

worked per week:

Employer: Address:

Job Title: Supervisor’s Name: Telephone Number: # of persons supervised by

you:

Date Employed (mo/yr) Starting Salary Ending Salary May we contact this Employer?

Date Separated (mo/yr) Reason for leaving

Full Time Years Months List major duties in order of importance in the job:

Part Time Years Months

If part time, average # of hours

worked per week:

SUMMARY OF QUALIFICATIONS
In the space below, describe briefly the experience, education, training, and other factors that qualify you for the position for which you are applying.
Refer to MINIMUM QUALIFICATIONS and POSITION-SPECIFIC QUALIFICATIONS posted for the job (if available).

CERTIFICATION

Disclosure of your social security number (SSN) is voluntary. Upon attainment of employment and pursuant to federal and state laws and
regulations, a request for SSN is mandatory. Your SSN may be used for purposes including but not limited to the following: identification of obli-
gors under child support orders, detection of welfare fraud, processing background checks and tax information, or general employee identification.
I certify that the answers I have given for all of the questions on this application are true and complete to the best of my knowledge. I
understand that if this application is not completed in entirety, it will not be processed and I will automatically be disqualified. I understand that I
am responsible for the accuracy of this application. I also understand that a background check may be required prior to employment, and that, in
accordance with the Drug-Free Workplace Program, drug testing may be required. I waive all provisions of law forbidding colleges or universities
which I attended, or past employers, from disclosing such information to the Human Resources Department of The Franklin County Engineer’s
Office, and to appropriate officials for recruitment purposes. I understand that any offer of employment is conditional upon proof of legal authoriza-
tion to work in the United States as required by the Immigrant Reform and Control Act.

________________________________________________________ _______________________________________
Signature of Applicant (unsigned applications will not be processed) Date
 Franklin County Engineer’s Civil Service Application Addendum
Equal Employment Opportunity Information
Cornell R. Robertson, P.E., P.S.— Franklin County Engineer
Franklin County is an Equal Opportunity Employer and provider of ADA services.

We request that you fill in the following information in order to assist our equal employment opportunity efforts.
This information is voluntary and will in no way affect the processing of your application of your being considered
for employment. Federal law prohibits unlawful discrimination on the basis of race, color, sex, age, national origin,
religion, or disability. Do not include your name on this page.
Date of Birth Gender How did you learn about this position?
□ Electronic/computer posting
___________________________________ □ Male □ Female
□ Paper vacancy posting
Month Day Year □ Newspaper
□ Other _________________________________
Ethnicity

□ White: a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

□ Black or African American: a person having origins in any of the black racial groups of Africa.

□ Hispanic or Latino: a person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish
culture or origin, regardless of race.
□ Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent
including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
□ Native Hawaiian or Other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Sa-
moa, or other Pacific Islands.
□ American Indian or Alaska Native: a person having origins in any of the original peoples of North and South America
(including Central America), and who maintains tribal affiliation or community attachment.
□ Two or More Races: a person who primarily identifies with two or more of the above race/ethnicity categories.

Disability

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a
major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
Blindness Autism Bipolar disorder Post-traumatic stress disorder (PTSD)

Deafness Cerebral palsy Major depression Obsessive compulsive disorder

Cancer Epilepsy Multiple sclerosis (MS) Impairments requiring the use of a wheelchair

Diabetes Schizophrenia Missing limbs or partially missing limbs Intellectual disability

Please check one of the boxes below:

□ Yes, I have a disability (or previously had a disability)

□ No, I do not have a disability

□ I do not wish to answer

Veteran Status
Have you served honorably in the Armed Forces of the United States on active duty for reasons other than training? □ Yes □ No

If yes, do you wish to declare a service-connected disability? □ Yes □ No

Revised 06/17