Fillable APPLICATION FOR EMPLOYMENT (Greene County Board of Commissioners)

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APPLICATION FOR EMPLOYMENT (Greene County Board of Commissioners)

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BROWSE GREENE COUNTY BOARD OF COMMISSIONERS (GA) FORMS

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APPLICATION FOR EMPLOYMENT
GREENE COUNTY BOARD OF COMMISSIONERS
1034 Silver Drive
Suite 201
Greensboro, GA 30642
FAX # 706-453-9555
PHONE # 706- 453-7716
GENERAL INFORMATION
Evaluations of applications are based on individual merit. Information MUST BE COMPLETE so that all applications can
be given equitable consideration. All qualified applicants will receive consideration for employment regardless of race,
color, religion, sex, age, national origin or disability. Greene County will hire only authorized workers, regardless of
national origin. This application must be typed or printed. Please complete one application for each position for which
you apply. YOU MUST SIGN AND DATE YOUR APPLICATION IN INK. INCOMPLETE APPLICATIONS MAY
BE REJECTED. RESUMES ARE NOT ACCEPTED IN LIEU OF A COMPLETED APPLICATION.
PERSONAL DATA
Job Announcement Closing Date________________________
Position Desired ___________________________________ Salary Requirement ______________________
Name _____________________________________________________________________________________________
first middle initial last
Address ___________________________________________________________________________________________
street apt. #
city
state
zip code
Telephone Numbers(______)___________________(______)____________________(______)____________________
home
work
other
How did you hear of this opening? ________________________________ Date available to begin work? ____________
Have you ever worked for Greene County Gov't.? Yes No When & Where? ____________________________
Give name, relationship and department of any relatives who are employed with Greene County Gov't.
__________________________________________________________________________________________________
Will you accept: Temporary work? Yes No Part-time work? Yes No
Shiftwork? Yes No Week-end/Holiday? Yes No
Are you over 18 years old? Yes No
Are you a citizen of the U.S.? Yes No
Are you legally eligible to work in the U.S.? Yes No
NOTE: If offered employment you will be required to provide documentation to verify employment eligibility. Failure to provide the
requested documentation may result in a determination that the applicant is ineligible for employment in the United States.
Email Address ___________________________________________________________________________________
Do you have a valid Drivers License? Yes No License # _________________________________ State __________
Do you have a valid Commercial Drivers License? Yes No What Classification? __________________________
NOTE: Possession of a valid drivers license is not an essential function of all employment offered by the County. Answering "No" to this
question is not necessarily a bar to consideration for employment. If offered employment, applicants will be required to obtain a
current copy of their Motor Vehicle Records Report from the appropriate designated agency and provide it to Greene County.
Have you received any traffic citations in the past 3 years? Yes No
Please indicate type of offense and dates ______________________________________________________________________
_______________________________________________________________________________________________________
Have you (since the age of 18) ever been convicted of or plead guilty or no contest to a misdemeanor? Yes No
Have you (since the age of 18) ever been convicted of or plead guilty or no contest to a felony? Yes No
If YES, describe circumstances _____________________________________________________________________________
_______________________________________________________________________________________________________
NOTE: Any applicant convicted of any criminal offense involving the manufacture, distribution, trafficking, or sale of a controlled
substance, dangerous drugs or marijuana, or convicted of any felony involving a violent crimes such as assault with a deadly weapon,
aggravated assault or murder are ineligible for employment with Greene County. Such applicants shall be automatically rejected.
Applicants convicted of any other felony will be considered on a case-by-case basis. Any applicant who has been convicted of any felony or
misdemeanor and has received a pardon from the appropriate State Pardons/Parole Board shall be eligible for employment with the County.
By signing this application, applicants agree to submit to a background investigation by Greene County and will also be required to submit
to pre-employment drug testing as designated and provided for by the County.
Have you ever been suspended, dismissed or asked to resign from any job? Yes No
If YES, explain in detail ___________________________________________________________________________________
_______________________________________________________________________________________________________
EDUCATION
HIGH SCHOOL
Name: ___________________________________________________ Location: ____________________________________
Circle the highest grade completed: 7 8 9 10 11 12 Graduated? Yes No
If not a high school graduate, do you have a GED? Yes No
COLLEGES/UNIVERSITIES
NAME OF SCHOOL
CITY
STATE
HRS.
EARNED
QTRS.
EARNED
MAJOR
DEGREE
EARNED
Describe special vocational or business courses you have taken which relate to the job for which you are applying.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Special skills, qualifications, and certifications (including language skills, typing skills, and business equipment or machine
operating skills) which relate to the job for which you are applying.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
WORK HISTORY
Describe your work history BEGINNING WITH YOUR CURRENT OR MOST RECENT JOB. Include military, volunteer experience and periods of
unemployment. Failure to give complete information regarding each job held will result in your disqualification. Complete address with zip code
and phone numbers for all employers are necessary. A resume may be attached only as additional information and will not be accepted in lieu of
completing this section.
Name of Organization or Firm
Telephone
( ) -
Dates Employed
From Mo/Yr To Mo/Yr
Address
Street City State Zip Code
Total Time Employed:
Official Job Title
Name of Supervisor
Pay
Start End
Describe Specific Job Duties
Specific Reason for Leaving
Name of Organization or Firm
Telephone
( ) -
Dates Employed
From Mo/Yr To Mo/Yr
Address
Street City State Zip Code
Total Time Employed:
Official Job Title
Name of Supervisor
Pay
Start End
Describe Specific Job Duties
Specific Reason for Leaving
Name of Organization or Firm
Telephone
( ) -
Dates Employed
From Mo/Yr To Mo/Yr
Address
Street City State Zip Code
Total Time Employed:
Official Job Title
Name of Supervisor
Pay
Start End
Describe Specific Job Duties
Specific Reason for Leaving
Name of Organization or Firm
Telephone
( ) -
Dates Employed
From Mo/Yr To Mo/Yr
Address
Street City State Zip Code
Total Time Employed:
Official Job Title
Name of Supervisor
Pay
Start End
Describe Specific Job Duties
Specific Reason for Leaving
Please use this space for additional information pertinent to your education, training and experience:
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
AUTHORIZATION TO RELEASE INFORMATION
I have made application for employment with Greene County Government. I authorize my former employers to give any information
regarding my employment and/or any information they have regarding me, whether or not it is in their records. I hereby release them
from any damage whatsoever for issuing same.
May we contact your present employer? Yes No Other_______________________________________________________
You must sign the "Authorization to Release Information" statement to enable us to contact prior employers, even though we may not
contact your present employer.
Date ___________________________ Applicant's Signature_____________________________________________________
APPLICANTS CERTIFICATION AND AGREEMENT
I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I am aware that
the falsification of this application or the omission of complete information will result in disqualification, or upon discovery,
termination of employment. The County is hereby authorized to make any investigation of my prior educational and work history.
Date ___________________________ Applicant's Signature__________________________________________________
Resumes, letters of reference, etc. submitted with the application become property of Greene County
and cannot be returned. The information you have provided on the application is subject to public
disclosure under the Georgia Open Records Act.
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APPLICATION FOR EMPLOYMENT (Greene County Board of Commissioners)

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Completed 9 August 2020

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