Application For Employment Form - Horry County Government - Human Resources Department Page 2
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2List jobs in reverse order starting with your present job. List your entire work history including volunteer, part-time, temporary, self-employment, and military jobs.
List promotion as a separate job. This section must be accurate and complete. If more space is needed, attach additional sheets in the same format, including your
name, social security number, and signature.
1. Employer: ____________________________ Address: __________________________________________________________
From Mo/Yr.__________ To Mo/Yr.__________ Hrs. Per Week: __________ Your Title: ________________________________
Last Salary: $_________ Supervisor: ________________ May We Contact? YES NO Phone: ___________________________
Name on Employment Records if Different From Present Name: ___________________________________________________
Reason for Leaving: ________________________________________________________________________________________
Duties: ___________________________________________________________________________________________________
_________________________________________________________________________________________________________
2. Employer: ____________________________ Address: __________________________________________________________
From Mo/Yr.__________ To Mo/Yr.__________ Hrs. Per Week: __________ Your Title: ________________________________
Last Salary: $_________ Supervisor: ________________ May We Contact? YES NO Phone: ___________________________
Name on Employment Records if Different From Present Name: ___________________________________________________
Reason for Leaving: ________________________________________________________________________________________
Duties: ___________________________________________________________________________________________________
_________________________________________________________________________________________________________
3. Employer: ____________________________ Address: __________________________________________________________
From Mo/Yr.__________ To Mo/Yr.__________ Hrs. Per Week: __________ Your Title: ________________________________
Last Salary: $_________ Supervisor: ________________ May We Contact? YES NO Phone: ___________________________
Name on Employment Records if Different From Present Name: ___________________________________________________
Reason for Leaving: ________________________________________________________________________________________
Duties: ___________________________________________________________________________________________________
_________________________________________________________________________________________________________
4. Employer: ____________________________ Address: __________________________________________________________
From Mo/Yr.__________ To Mo/Yr.__________ Hrs. Per Week: __________ Your Title: ________________________________
Last Salary: $_________ Supervisor: ________________ May We Contact? YES NO Phone: ___________________________
Name on Employment Records if Different From Present Name: ___________________________________________________
Reason for Leaving: ________________________________________________________________________________________
Duties: ___________________________________________________________________________________________________
_________________________________________________________________________________________________________
REFERENCES
Give names and addresses of three people, not relatives or former employers, who have known you for at least one year.
NAME
ADDRESS
TEL. NUMBER
1. ______________________________________________________________________________________________________
2. ______________________________________________________________________________________________________
3. ______________________________________________________________________________________________________
NEITHER THIS APPLICATION NOR AN INTERVIEW CONSTITUTES A CONTRACT OF EMPLOYMENT AND, IF HIRED, ALL
EMPLOYEES OF THE COUNTY ARE EMPLOYEES-AT-WILL WHO MAY QUIT AT ANY TIME FOR ANY OR NO REASON AND
MAY BE TERMINATED AT ANY TIME FOR ANY OR NO REASON.
CERTIFICATION OF APPLICANT
I affirm, agree, and/or understand that all statements on this form are true and accurate and any misrepresentation or omission of facts
may result in my disqualification for consideration for the position applied for or my discharge from the position should I already be
employed. I understand you may inquire into my background and conduct a fingerprint check. If I have requested herein that my
employer not be contacted, an offer of employment may be conditioned upon acceptable information and verification from such
employer prior to beginning work.
SIGNATURE ___________________________________________DATE ____________________________
AUGUST 1999
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