Saline County Arkansas
General Application for Employment
Saline County Courthouse
% Personnel Office
200 N. Main Street, Room 112
Benton, AR 72015
Ph #: 501-303-5658
Fax #: 501-315-1338
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
PLEASE PRINT
Positions applied for: __________________________ Date of application: __________
______________________________ __________________________ __________
Last Name First Name Middle Name
______________________________ ______________________ ______ _______
Address City State Zip Code
(_____)_______-____________ _________-________-________________
Telephone Number with area code Social Security Number
If you are under 18 years of age, can you provide required proof of your eligibility to work?
Yes _____ No _____
Have you ever filed an application with us before? Yes _____ No _____
If yes, give date: __________________________
Have you ever been employed with us before? Yes _____ No _____
If yes, give date: ________________________________________
Are you currently employed? Yes _____ No _____
May we contact your present employer? Yes _____ No _____
Are you prevented from lawfully becoming employed in the country because of Visa or Immigration Status?
Yes _____ No _____ Proof of citizenship or immigration status will be required upon employment.
On what date would you be available for work? ________________________________
Are you available to work: Full Time ___ Part Time ___ Shift Work ___ Temporary ___
Are you currently on "lay-off" status and subject to recall? Yes _____ No _____
Have you been convicted of a felony within the last 7 years? Yes _____ No _____
Conviction will not necessarily disqualify an applicant from employment.
If yes, please explain: ____________________________________________________
_____________________________________________________________________
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Education
Please list Name and address of school, course of study, years completed and diploma degree.
Elementary School _____________________________________________________
____________________________________________________________________
High School __________________________________________________________
____________________________________________________________________
Undergraduate College __________________________________________________
____________________________________________________________________
Other (Specify) ________________________________________________________
____________________________________________________________________
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Employment Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.
1. Employer: ________________________________ Dates: ____________________
Address: ___________________________________________________________
Work Preformed: ____________________________________________________
Telephone Number(s): _________________________________________________
Hourly rate/salary: ___________________ Starting: ___________ Final: __________
Job Title: _______________________ Supervisor: __________________________
Reason for leaving: ____________________________________________________
___________________________________________________________________
___________________________________________________________________
2. Employer: ________________________________ Dates: ____________________
Address: ___________________________________________________________
Work Preformed: ____________________________________________________
Telephone Number(s): _________________________________________________
Hourly rate/salary: ___________________ Starting: ___________ Final: __________
Job Title: _______________________ Supervisor: __________________________
Reason for leaving: ____________________________________________________
___________________________________________________________________
___________________________________________________________________
3. Employer: ________________________________ Dates: ____________________
Address: ___________________________________________________________
Work Preformed: _____________________________________________________
Telephone Number(s): _________________________________________________
Hourly rate/salary: ___________________ Starting: ___________ Final: __________
Job Title: _______________________ Supervisor: __________________________
Reason for leaving: ____________________________________________________
___________________________________________________________________
___________________________________________________________________
4. Employer: ________________________________ Dates: ____________________
Address: ___________________________________________________________
Work Preformed: _____________________________________________________
Telephone Number(s): _________________________________________________
Hourly rate/salary: ___________________ Starting: ___________ Final: __________
Job Title: _______________________ Supervisor: __________________________
Reason for leaving: ____________________________________________________
___________________________________________________________________
___________________________________________________________________
(If you need additional space, please continue on a separate sheet of paper.)
List 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 other protected status:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Additional Information
Other qualifications:
Summarize special job-related skills and qualifications acquired from employment or other experience.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Specialized Skills
Check Skills/Equipment Operated
Production Mobile Machinery (list) Other (list)
___ CRT ___ FAX ________________ _______________
___ PC ___ Wordperfect ________________ _______________
___ Calculator ___ Excel ________________ _______________
___ Typewriter ________________ _______________
By signing this employment application, I certify that I am in compliance with the Military Selective Service Act.
__________________________________ _________________________________
Signature Date
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENT OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A description of the activities involved in such a job or occupation is attached.
Yes _____ No _____
References
1. Name: _______________________________ Ph #: (_____)________-_________
Address: ____________________________________________________________
2. Name: _______________________________ Ph #: (_____)________-__________
Address: _____________________________________________________________
3. Name: _______________________________ Ph #: (_____)________-__________
Address: _____________________________________________________________
Applicant's Statement
I certify that answers given here in 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 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
________________________________ __________________________
Signature of Applicant Date
FOR PERSONNEL DEPARTMENT USE ONLY
Arrange Interview Yes _____ No _____
Remarks: _____________________________________________________________
_____________________________________________________________________
Interviewer: ________________________________ Date: ____________________
Employed: Yes_____ No_____ Date of Employment: _______________________
Job Title: _______________ Hourly Rate/Salary: _________ Department: ____________
By Name & Title: _______________________________________ Date: ___________
Notes: _______________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
This application For Employment is sold for general use throughout the United States. Amsterdam Printing and Litho Corp. assumes no responsibility for the use of said form or any questions which, when asked by the employer of the job applicant, may violate State and/or Federal Law.
FOR PERSONNEL DEPARTMENT USE ONLY
Position(s) Applied For Is Open: Yes _____ No _____
Position(s) Considered For: ______________________________________________
______________________________________________
Date: ______________________________________________
NOTES: ________________________________________________
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