APPLICATION FOR EMPLOYMENT

SALINE COUNTY ROAD DEPARTMENT

(VOID AFTER 3 MONTHS)

 

Persons seeking employment with Saline County must be at least 16 years of age for temporary employment or 18 for permanent employment.

 

PLEASE PRINT PLAINLY

 

DATE:_______________

 

NAME:___________________________________________________      

                        Last, First, Middle Initial

 

SS#:______-____-______                               

 

ADDRESS:__________________________   CITY:___________________ 

 

STATE: ____________________            ZIP:______________ 

 

TELEPHONE:____________________________   

 

DATE OF BIRTH:_________________________

 

TYPE OF WORK DESIRED

 

_____ FULL TIME   _____ SUMMER   _____ PART-TIME

 

POSITION: _______ LABOR _____ TRUCK DRIVER _____ OPERATOR

 

DRIVER’S LICENSE NO.:_____________________________

 

CDL CLASS: ______________________

 

GRADE LAST COMPLETE IN SCHOOL _______________________ 

 

HAVE YOU EVER WORKED FOR THE COUNTY BEFORE? ______  

 

WHAT POSITION: ___________________ 

 

IF YES, WHEN AND WHAT POSITION: ____________________________________________________________ 

 

ARE YOU CURRENTLY EMPLOYED? ________  IF SO, MAY WE CONTACT YOUR EMPLOYER?__________

 

HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST 7 YEARS? ____________________________________________________________________

 

IF YES, PLEASE EXPLAIN: ______________________________________________________________________

IF HIRED, DO YOU HAVE A RELIABLE MEANS OF TRANSPORTATION TO WORK? ____________________________________________________

 

IF HIRED, ON WHAT DATE WILL YOU BE ABLE TO START TO WORK? _________________________

 

EMPLOYMENT EXPERIENCE:

 

 

    EMPLOYER                                      DATES EMPLOYED                      TELEPHONE NO.

 

1.    ________________________________________________________________________

 

JOB DESCRIPTION:__________________________________________________________

 

2.    _______________________________________________________________________ 

 

JOB DESCRIPTION:  _________________________________________________________

 

ADDITIONAL SKILLS OR INFORMATION: ___________________________________________________________________________

 

___________________________________________________________________________

 

___________________________________________________________________________

 

 

REFERENCES:

 

 

     NAME                                     ADDRESS                        PHONE                 OCCUPATION

1.__________________________________________________________________________

 

2.__________________________________________________________________________

 

3.__________________________________________________________________________

 

 

BY SIGNING THIS EMPLOYMENT APPLICATION, I CERTIFY THAT I AM IN COMPLIANCE WITH THE MILITARY SELECTIVE SERVICE ACT.

 

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 90 DAYS.

 

I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT IN THE EVENT OF EMPLOYMENT, I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION GIVEN IN MY APPLICATION OR INTERVIEW MAY RESULT IN DISCHARGE.  I UNDERSTAND, ALSO, THAT I AM REQUIRED TO ABIDE BY RULES AND REGULATIONS OF THE EMPLOYER.

 

 

SIGNATURE: ________________________________   DATE:______________________