Date of Birth:    Salary Required   Date

2. Address Information
   
3. E-Mail Address:
4. Are you over 18 years old Yes  No    If no, you may be required to provide authorization to work.
5. Are you legally eligible to be employed in the United States? Yes    No  Proof of identity and eligibility will be required upon employment.
6. Yes     No   Do you have a valid driver’s license if required by the position for which you are applying?  License # 
7. Yes    No    Has your driver's license ever been revoked or suspended? If yes, please indicate period of suspension and reason.
   
8.  Yes   No  Have you ever been convicted of violating any law (omit minor traffic violations)? If yes, list conviction(s), date(s), and place(s). Conviction is not an automatic rejection. All applicants shall have a criminal records/background check.
   
9. If you are a male between the ages of 18 and 26, have you registered under the Section 3(a) Military Selective Service Act of 1948?
   Yes No
   
10. Date avaliable for work:   Type of Work  Full Time   PartTime   Temporary

Provide copies of the following: (1) GED certificate; (2) high school diploma/ transcript; (3) vocational/technical school transcript; or (4) college transcript with an official seal & Registrar's signature. NOTE: Education must be verified 90 days after hire/promotion or appointment will be terminated.

Can you type: Yes  No  Words per minute: 
Education completed:
GED Yes  No  Year Complete 
Grade School: Yes  No   
Middle School (completed 6,7,8)  High School (completed 6,7,8)  College (completed 1,2,3,4)  Graduate School (completed 1,2,3,4)

School	Name	Dates Attended		Graduation M/Y	Number of Hours		Fields of Study		Degree, Diploma, or Certificate
		From M/D/Y	To M/D/Y		Earned	Now Carry	Major	Minor
High School									Diploma Yes  No
Under Graduate College or University
Graduate College or University
Vocational, Business, Technical
Apprenticeship				Program Length:		Journeyman: Yes   No			Must Provide Certificate

EMPLOYMENT HISTORY: Begin with your most recent job and provide as much detail as possible. Be sure to complete each blank in this section thoroughly and accurately as changes you wish to make after submitting this application must be verified by the employer. If you changed positions within the same organization and your duties changed, describe each job in a separate block. When listing job duties, list those that took most of your time first. If your application reflects incomplete or conflicting information (including employment dates and average hours) you will receive partial or no credit for that job. NOTE: You must complete this application form as resumes are not considered official, but may be submitted if signed and dated.

May we contact your present employer? Yes  No   If no explain
Employed From		Employed To				Starting Salary
PositionTitle		Grade				Ending Salary
Average hours worked per week		Reason for leaving:
Name of Employer:
Address Line 1
City, State, Zip
Type of Business					Phone
Title and Name of your supervisor:
Supervisor continued
I was a supervisor From	-		I was a supervisor To		-

EMPLOYMENT HISTORY: Begin with your most recent job and provide as much detail as possible. Be sure to complete each blank in this section thoroughly and accurately as changes you wish to make after submitting this application must be verified by the employer. If you changed positions within the same organization and your duties changed, describe each job in a separate block. When listing job duties, list those that took most of your time first. If your application reflects incomplete or conflicting information (including employment dates and average hours) you will receive partial or no credit for that job. NOTE: You must complete this application form as resumes are not considered official, but may be submitted if signed and dated.

Employed From		Employed To				Starting Salary
PositionTitle		Grade				Ending Salary
Average hours worked per week		Reason for leaving:
Name of Employer:
Address Line 1
City, State, Zip
Type of Business					Phone
Title and Name of your supervisor:
Supervisor continued
I was a supervisor From	-		I was a supervisor To		-

EMPLOYMENT HISTORY: Begin with your most recent job and provide as much detail as possible. Be sure to complete each blank in this section thoroughly and accurately as changes you wish to make after submitting this application must be verified by the employer. If you changed positions within the same organization and your duties changed, describe each job in a separate block. When listing job duties, list those that took most of your time first. If your application reflects incomplete or conflicting information (including employment dates and average hours) you will receive partial or no credit for that job. NOTE: You must complete this application form as resumes are not considered official, but may be submitted if signed and dated.
C

Employed From		Employed To				Starting Salary
PositionTitle		Grade				Ending Salary
Average hours worked per week		Reason for leaving:
Name of Employer:
Address Line 1
City, State, Zip
Type of Business					Phone
Title and Name of your supervisor:
Supervisor continued
I was a supervisor From	-		I was a supervisor To		-

EMPLOYMENT HISTORY: Begin with your most recent job and provide as much detail as possible. Be sure to complete each blank in this section thoroughly and accurately as changes you wish to make after submitting this application must be verified by the employer. If you changed positions within the same organization and your duties changed, describe each job in a separate block. When listing job duties, list those that took most of your time first. If your application reflects incomplete or conflicting information (including employment dates and average hours) you will receive partial or no credit for that job. NOTE: You must complete this application form as resumes are not considered official, but may be submitted if signed and dated.
D

Employed From		Employed To				Starting Salary
PositionTitle		Grade				Ending Salary
Average hours worked per week		Reason for leaving:
Name of Employer:
Address Line 1
City, State, Zip
Type of Business					Phone
Title and Name of your supervisor:
Supervisor continued
I was a supervisor From	-		I was a supervisor To		-

EMPLOYMENT HISTORY: Begin with your most recent job and provide as much detail as possible. Be sure to complete each blank in this section thoroughly and accurately as changes you wish to make after submitting this application must be verified by the employer. If you changed positions within the same organization and your duties changed, describe each job in a separate block. When listing job duties, list those that took most of your time first. If your application reflects incomplete or conflicting information (including employment dates and average hours) you will receive partial or no credit for that job. NOTE: You must complete this application form as resumes are not considered official, but may be submitted if signed and dated.
E

Employed From		Employed To				Starting Salary
PositionTitle		Grade				Ending Salary
Average hours worked per week		Reason for leaving:
Name of Employer:
Address Line 1
City, State, Zip
Type of Business					Phone
Title and Name of your supervisor:
Supervisor continued
I was a supervisor From	-		I was a supervisor To		-

EMPLOYMENT HISTORY: Begin with your most recent job and provide as much detail as possible. Be sure to complete each blank in this section thoroughly and accurately as changes you wish to make after submitting this application must be verified by the employer. If you changed positions within the same organization and your duties changed, describe each job in a separate block. When listing job duties, list those that took most of your time first. If your application reflects incomplete or conflicting information (including employment dates and average hours) you will receive partial or no credit for that job. NOTE: You must complete this application form as resumes are not considered official, but may be submitted if signed and dated.
F

Employed From		Employed To				Starting Salary
PositionTitle		Grade				Ending Salary
Average hours worked per week		Reason for leaving:
Name of Employer:
Address Line 1
City, State, Zip
Type of Business					Phone
Title and Name of your supervisor:
Supervisor continued
I was a supervisor From	-		I was a supervisor To		-

1. LICENSES OR CERTIFICATES: If required for the position you must provide a copy or verification of the license or certificate.
        Yes No  I hold a current license or certification as indicated below and understand if hired, I must maintain a current license or certification or be subject to dismissal.
   

   License or Certification Title & Number	Original Issue Date	Current Expiration Date	Name, Address & Phone of Licensing Agency

   
   
2.  PROFESSIONAL ORGANIZATIONS: Indicate current membership in professional organizations.
   

   ORGANIZATION	TITLE	DATE MEMBERSHIP EXPIRES

   
   
3.  CHARACTER REFERENCES: Other than relatives, former employers, or supervisors.
   

   Name	Address	Phone Number

Signature -  Please read and sign the following statement: I certify, under penalty of law, that the information given in this application is correct and complete to the best of my knowledge. I am aware that, should investigation at any time show falsification, I will not be considered for employment or, if employed, I will be dismissed. I hereby authorize Franklin County Fiscal Court to make all necessary investigations concerning me, my work habits, character, or my action in any transaction. I authorize Franklin County Fiscal Court to receive my academic records or other material pertinent to my qualifications, and further authorize and request each former employer, person given as a reference, educational institution, or organization (including law enforcement agencies) to provide all information that may be sought in connection with my application. I understand and agree that I will be required to ratify the information contained in this application by signature as a condition of employment. I also understand that Franklin County Fiscal Court is a drug free workplace.

Signature:	Date