Employment Application

County of Bleckley

Postion Applied For:

Personal Information

First Name

Middle Name

Last Name

Address

Address Line 1

City

State

Zip Code

Primary Contact Number

Other Contact Number

When would you be available for work?

Have You ever been convicted of a felony

Yes

Do you hold a current driver's license

Yes

License Number and Type

Do you hold a professional license

yes

License Number and Type

Education

Grammar School Level Completed

GED Equivalent

Yes

Secondary School Level Completed

Course of Study

Degree/Diploma

Please describe any specialized training and/or skills

Employment History

Describe your work history beginning with your current or most recent job. A resume may be provided for additional information.

Attach your resume

Choose File

Employer

Type of business

Address

Address Line 1

City

State

Zip Code

Employer's Phone Number

Employed from

Immediate Supervisor

Employed to

Your position

Specific Dutiies

Reason for leaving

May we contact the employer in question?

Yes

Additional Employer

Yes

Employer

Type of business

Address

Address Line 1

City

State

Zip Code

Employer's Phone Number

Employed from

Immediate Supervisor

Employed to

Your position

Specific Dutiies

Reason for leaving

May we contact the employer in question?

Yes

Add another employer

Yes

Employer

Type of business

Address

Address Line 1

City

State

Zip Code

Employer's Phone Number

Employed from

Immediate Supervisor

Employed to

Your position

Specific Dutiies

Reason for leaving

May we contact the employer in question?

Yes

Personal References

Name

Place of business

Relation

Contact Number

Name

Place of business

Relation

Contact Number

Name

Place of business

Relation

Contact Number

I hereby certify that all statements made on this application are true to the best of my knowledge. I fully realize that should an investigation disclose any misrepresentation, I will be subject to disqualification and/or immediate dismissal.

Bleckley County is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Bleckley County has established the goal of a 100% drug- and alcohol-free workplace. Applicants will be required to undergo drug and alcohol testing prior to employment and will be subject to random testing throughout their employment.

Signature

Date