Fillable Employment Application Form (Page 2 of 2) in pdf

NO RESUME WILL BE ACCEPTED UNLESS ACCOMPANIED BY A FULLY COMPLETED APPLICATION

WORK

Please provide a complete record of your employment history including part-time work, military services and volunteer experience. List all

experience in order, starting with your present or most recent position and working back. Describe your duties and responsibilities in each

HISTORY

position thoroughly so that your experience may be fairly evaluated. Account for all periods of unemployment.

Name and title of immediate supervisor

Dates of employment

Name of employing firm

__________________________________________________

Telephone Number

_________ to __________

________________________________________________________

________________________________________________

Mo/Yr

Mailing address

Reason for Leaving

full-time

part-time

(including zip code)

_________________________________________________

If part-time

________________________________________________________

Your name when employed if different from present

hours per week_________

Job Title

__________________________________________________

Description of duties

__________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

Machines and

equipment used

Dates of employment

Name of employing firm

Name and title of immediate supervisor

__________________________________________________

Telephone Number

_________ to __________

________________________________________________________

________________________________________________

Mo/Yr

Mailing address

Reason for Leaving

full-time

part-time

(including zip code)

_________________________________________________

If part-time

________________________________________________________

Your name when employed if different from present

hours per week_________

Job Title

Description of duties

______________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________

Machines and

equipment used

Dates of employment

Name of employing firm

Name and title of immediate supervisor

_________________________________________________

Telephone Number

_________ to __________

________________________________________________________

________________________________________________

Mo/Yr

Mailing address

Reason for Leaving

full-time

part-time

(including zip code)

_________________________________________________

If part-time

________________________________________________________

Your name when employed if different from present

hours per week_________

Job Title

Description of duties

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

Machines and

equipment used

Use this space for any special qualifications and skills (i.e., skills with construction or office equipment, publications, etc.) or additional information that you feel will help us

to evaluate your application__________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

May we contact your

Yes

Present

Yes

If no,

former employers?

employers?

why? ___________________________________________________________________

REFERENCES

Please list two persons, other than relatives or former employers, who know your qualifications or who know your character.

Name ___________________________________________________________

Name :______________________________________________________

Address:_________________________________________________________

Address:___________________________________________________________

City, State, Zip Code:________________________________________________

City, State, Zip Code:__________________________________________________

Phone Number ___________________________________________________

_______________________________________________________

__________________________________

Applicant’s Signature

Date

I hereby affirm that all statements made herein are true and correct. I authorize the County to conduct whatever investigation(s) it deems necessary to confirm the statements

submitted on this application. If investigation(s) determines any untrue statement(s) was made, I accept this as sufficient grounds for refusal to hire, or dismissal.

I also authorize and request each former employer and person, firm or corporation given as reference to answer any and all questions that may be asked and to give any and

all information that may be sought in connection with this application concerning my work habits, character and skill.

I agree to submit myself, upon request, for physical examination by a physician selected by the County and understand that failure to meet the physical requirements may

disqualify me for employment. I understand I must submit myself for drug testing prior to my being employed by the County. Failure of the test will disqualify me for the

position offered.

The use of this application form does not indicate that there are any positions available, and in no way obligates the County.

______________________________________________________

___________________________________

Applicant’s Signature

Date