Employment Application

1. First Name
2. M/I
3. Last Name
4. Alias(s), maiden, nicknames, any other names used
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. Alternate Phone
11. Email
12. Job Applied for Choose an open position.
13. Date Available
14. Are you at least 18 years of age? Please Select Yes No
15. Can you, after employment, submit verification of your legal right to work in the United States? Please Select Yes No
16. Have you ever been employed by Jones County? Please Select Yes No
Employed Start Date:
Employed End Date:
Employed Position
Reason for Leaving
17. Do you have relatives employed by us? Please Select Yes No
If yes, please list the relatives.
18. How did you learn about the position? (Newspaper, radio, personnel announcement, walk in, etc.)

VETERAN'S PREFERENCE

1. Are you a U.S. Veteran? Please Select Yes No
2. Are you a member of the reserves or National Guard? Please Select Yes No
3. Those wishing to claim veteran’s preference MUST SUBMIT PROOF OF SERVICE (DD 214) which includes dates of active duty
   only PDF files are allowed

EDUCATION RECORD

High School

1. Name and Location
2. Did you graduate? Please Select Yes No No, but received GED

College or Trade School

1. Name and Location
2. Did you graduate? Please Select Yes No
3. Major/Subject
4. Have you received any additional training — workshops, short courses, volunteer work, etc?
5. Do you have any other experience or qualifications not listed which relates to the job applied for? List any office equipment, machines, or other equipment you operate.

Employment History

Employer 1

1. Employer Name
2. Job Title
3. Address
4. City
5. 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
6. Zip
7. Phone
8. Start Date
9. End Date
10. Current/Ending Pay
11. Supervisor Name
12. Work Performed
13. Reason for Leaving
14. Can we contact current employer? Please Select Yes No
Add Employer

Employer 2

Employer Name

Job Title

Address

City

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

Zip

Phone

Start Date

End Date

Current/Ending Pay

Supervisor Name

Work Performed

Reason for Leaving Add Employer

Employer 3

Employer Name

Job Title

Address

City

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

Zip

Phone

Start Date

End Date

Current/Ending Pay

Supervisor

Work Performed

Reason For Leaving
15. Additional Employers
16. Have you ever been discharged from a job? Please Select Yes No
If yes, please list the employer, dates, and provide an explanation

Upload Resume and Cover Letter

Resume and cover letters may be required for certain positions. See job description for requirements.

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

References

Please list three personal references, other than prior employers or relatives, whom we can contact.

Reference 1

1. Name
2. Phone
3. How long have you known this reference?
4. Occupation

Reference 2

5. Name
6. Phone
7. How long have you known this reference?
8. Occupation

Reference 3

9. Name
10. Phone
11. How long have you known this reference?
12. Occupation

Additional Information

1. List any professional, trade groups, organizations, machinery/tools operated in the past, and/or special skills that you consider relevant to your ability to perform this job.
   
   This may also include relevant professional licenses. if listing licenses, please include the license type, certificate number, state of issue, and expiration date.
2. Have you ever been convicted of a felony?
   For purposes of these questions, convicted includes plead guilty, plead no contest, or been given a deferred sentence of judgment. Please Select Yes No
If yes, please explain.
Note: A conviction will not automatically disqualify an applicant for a particular job and that the type and seriousness of the crime, the frequency of violoations, the date of conviction, and the applicant's entire work and educational history will be considered.

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Job Description

3. Have you read the job description? Please Select Yes No
4. Do you understand the requirements? Please Select Yes No
5. Can you perform the requirement of this job with or without reasonable accommodations? Please Select Yes No

Driver's License

6. If the job requires, do you have the appropriate valid driver's license? N/A Yes No
Driver's License #
License Type
State of License 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
Have you had any moving violations? Please describe:

Applicant's Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this Application for Employment as may be necessary in arriving at an employment decision.

I authorize Jones County to conduct a check of the status of my driver’s license and my driving record and agree to sign an authorization for this specific purpose.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with Jones County is “at will” nature, which means that the Employee may resign at any time, and the Employer may discharge the Employee at any time with or without cause.

I understand that any offer of employment that is extended to me is considered to be a conditional offer and is subject to successful completion of all required background checks. Identifying information such as my social security number and driver’s license number may be requested at the post-offer, pre-employment stage.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge and that I am required to abide by all rules and regulations of the Employer.

I agree to give Jones County permission to complete appropriate background checks and agree to sign permission/authorization documents so that this can be accomplished.

Your Signature

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