Employment Application

Job Application

1. Last Name
2. First Name
3. Middle Name
4. Address
5. City
6. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
7. Zip
8. Phone
9. Email
10. Date available to work
11. The best time to contact you is
12. The position I am applying for is Choose an open position. Assistant County Engineer Payroll & Accounting Clerk Security Officer
13. Today's Date
14. How did you learn about the position?
15. Do you possess a valid Driver's License? Please Select Yes No
16. DL No
17. Do you possess a valid CDL License? Please Select Yes No
18. Class of CDL
19. Are you a U.S. Veteran? Please Select Yes No
20. Are you a member of the Reserves or National Guard? Please Select Yes No

Those wishing to claim Veteran's Preference MUST SUBMIT PROOF OF SERVICE (DD214) with includes dates of active duty.

21. Upload DD214 Form
    only PDF files are allowed



22. Are you available to work? Please Select Full Time Part Time Summer Temporary
23. Have you ever filled an application with Jackson County? Please Select Yes No
If yes, enter the month/year
24. Have you ever been employed by Jackson County? Please Select Yes No
Employed Start Date:
Employed End Date:
Employed Position
Reason for Leaving
25. Do you have any friends or relatives employed by Jackson County? Please Select Yes No
If yes, name, relationship and department in which they are employed
26. What is your desired salary range?
27. Are you at least 18 years of age? Please Select Yes No
28. Are you available to work overtime if required? Please Select Yes No
29. Are you willing to travel if required? Please Select Yes No
30. Are you prevented from lawfully becoming employed in this country because of Visa or immigration status? Please Select Yes No

(Proof of identity and eligibility will be required upon employment)

31. Have you ever been convicted of a crime (other than a minor traffic violation)? Please Select Yes No

A conviction record is not an automatic bar to employment and the nature, regency and disposition of the offense will be considered only as it relates to the job which you are applying.

If yes, please explain.

Education

High School

1. School Name/Location
2. Area of Concentration/Course of Study
3. Diploma/degree(s), certificates, licenses, endorsements

Undergraduate College/University

1. School Name/Location
2. Area of Concentration/Course of Study
3. Diploma/degree(s), certificates, licenses, endorsements

Graduate/Professional

1. School Name/Location
2. Area of Concentration/Course of Study
3. Diploma/degree(s), certificates, licenses, endorsements

Skills, Training, Equipment

1. Describe any skills, specialized training, apprenticeship, certifications, licensures, and/or qualifications acquired academically, from employment or other experience
2. List specialized equipment and computer software you can operate
3. List construction equipment previously operated (if applicable to the postion)

References

List references who are not related to you and are not previous employers.

Reference 1

1. Name
2. Address
3. City
4. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
5. Zip
6. Phone
7. Relationship

Reference 2

1. Name
2. Address
3. City
4. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
5. Zip
6. Phone
7. Relationship

Reference 3

1. Name
2. Address
3. City
4. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
5. Zip
6. Phone
7. Relationship

Employment History

List previous employment. Start with your present or most recent job.

Employer 1

1. Employer
2. Job Title
3. Start Date
4. End Date
5. Address
6. City
7. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
8. Zip
9. Phone
10. Supervisor
11. Hourly Rate/Salary Starting Pay
12. Hourly Rate/Salary Final Pay
13. Work Performed
14. Reason for Leaving
15. May we contact this employer? Please Select Yes No
If no, why?
Add Employer

Employer 2

1. Employer
2. Job Title
3. Start Date
4. End Date
5. Address
6. City
7. State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
8. Zip
9. Phone
10. Supervisor
11. Hourly Rate/Salary Starting Pay
12. Hourly Rate/Salary Final Pay
13. Work Performed
14. Reason For Leaving
15. May we contact this employer? Please Select Yes No
If no, why?
Add Employer

1. List any professional, trade, business or civic activities and offices held (you may exclude membership which would reveal gender, race, religion, national origin, age, ancestry disability or any other protected status)
2. List other experience, training, skills or ability that you believe will qualify you for the position for which this application is filed
3. Please provide any additional information you feel may be helpful to us in considering your application

Upload Resume

1. Resume
   only PDF files are allowed
2. Cover Letter
   only PDF files are allowed

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. If I wish to be considered for employment beyond this time period. I understand that I need to inquire as to whether or not applications are being considered at that time.

I hereby acknowledge that any employment relationship with Jackson County is of an at-will nature, which means that the employee may resign at any time and that Jackson County may discharge at any time with or without cause. I understand neither this document nor any offer of employment from Jackson County constitutes an employment contract unless a specific document to that effect is executed by Jackson County and be in writing.

I hereby acknowledge that as a condition of employment I may be required to submit to, and successfully pass, a criminal background check, credit history check, post-offer pre-employment physical and drug screen.

In the event of employment, I understand that false or misleading information given in my application or interview(s) shall be considered sufficient cause for dismissal. I further understand that an incomplete application or an absence of my signature on this application is just cause for rejection of this application. I agree to employment entrance exams, if necessary, at Jackson County cost. I understand that I am required to abide by all rules and regulations of the Employer.

Your Signature

1. Signature of Applicant Please type your full name to serve as an electronic signature.
2. Date