Town of Jackson, SC An Equal Opportunity Employer
APPLICATION FOR EMPLOYMENT
TOWN OF JACKSON
106 MAIN ST. / P.O. BOX 369
JACKSON, SOUTH CAROLINA 29831
PLEASE CAREFULLY READ THE FOLLOWING STATEMENTS
Authority to Release Information: By my signature, I consent to the release
of
information to authorized
officers, agents, and/or employees of the Town of
Jackson
, SC which may include but not be limited to information concerning my
past and present work; including my official personnel files; attendance records;
evaluations; educational records including transcripts; military service: law enforcement
records; and/or any personnel record deemed necessary. In
addition, I consent to
authorize appropriate officers, agents, and/or employees of the Town of Jackson, SC
to make inquiries of third parties such as credit bureaus. I further release the
organization, educational entity, present and former employers, law enforcement
organization, and all third parties for any and all claims of whatever nature that I may
have as
result of any inquiry or response given to such inquiries made in
connection with my application for employment.
Signature: ___________________________
Date: ______________________________
Certification of Applicant: By my signature, I affirm, agree, and understand
that all statements on this form are true and accurate. Any misrepresentation,
falsification, or material omission of inform of data on the application may result in
exclusion
from further consideration or, if hired, termination of employment. If I
have requested herein that
my present employer not be contacted, an offer of
employment may be conditioned upon acceptable information
and verification from
such employer prior to beginning work.
Signature: ___________________________
Date: ______________________________
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Town of Jackson, SC An Equal Opportunity Employer
APPLICATION FOR EMPLOYMENT
TOWN OF JACKSON
106 MAIN ST. / P.O. BOX 369
JACKSON, SOUTH CAROLINA 29831
INSTRUCTIONS TO APPLICANT:
1. Please type or print legibly in ink. Incomplete application will not be accepted. Application must have all
sections complete and the form signed by the applicant. A resume may be attached but not substituted
for the application.
2. All qualified applications will be referred to the department where the vacancy is located. That
department head or selected committee is responsible for the review and evaluation of applications
and recommending the qualified applicants to be selected for interview.
3. Applications will remain active until the vacancy is filled. If you wish to remain informed of positions
available, please contact the Town Clerk at (803) 471-2228.
4. All applicants will be asked to sign an Authority to Release Information and Certification of Applicant-
Please read these statements very carefully.
5. The Town of Jackson consider all applicants for all positions without regard to Race, Color, Religion,
Creed, Gender, National Origin, Age, Disability, Marital or Veteran Statuse, sexual orientation, or any
other legally protected status.
Town of Jackson, SC An Equal Opportunity Employer
APPLICATION FOR EMPLOYMENT
TOWN OF JACKSON
106 MAIN ST. / P.O. BOX 369
JACKSON, SOUTH CAROLINA 29831
1. POSITION APPLYING FOR:
Job Title: ___________________________
2. CONTACT INFORMATION:
Social Security Number: _________________________________Date of Birth: ____________________
3. EDUCATION:
High School: ____________________________Location:______________________________________
Diploma (Yes/No) Other (Specify) __________________Highest Grade Completed: ________________
College Graduate? Yes No
Undergraduate College/University:
Graduate School:
Degree and Year Obtained:
Degree and Year Obtained:
Job-Related Training and Course Work
List any skills, licenses, and certificates, which are related to the job you seek (including computer software
proficiency.)
NAME:______________________________
Phone #: ______
________ Address:_______________________________________________
APPLICATION FOR EMPLOYMENT
TOWN OF JACKSON
106 MAIN ST. / P.O. BOX 369
JACKSON, SOUTH CAROLINA 29831
4. WORK EXPERIENCE:
Describe your work experience in detail, beginning with your current or most recent job. Include military
service (indicate rank) and job related volunteer work, if applicable. Provide an explanation for any gaps in
employment. All information in this section must be complete. A resume may be attached, but not
substituted for completing this section.
1. Name of Present of Last Employer: __________________________________________________________
Address: _______________________________________________________________________________
Phone: ________________________ Job Title: ________________________________________________
Number Supervised:_____________Supervisor’s Name: _________________________________________
From: ___/____/____ To: ___/___/___ Hour Per Week: __________ Salary: _________________________
May we contact this employer? Yes No
Reason for Leaving:
2. Your Next Most Recent Employer: __________________________________________________________
Address: _______________________________________________________________________________
Phone: ________________________ Job Title: ________________________________________________
Number Supervised:_____________Supervisor’s Name: _________________________________________
From: ___/____/____ To: ___/___/___ Hour Per Week: __________ Salary: _________________________
May we contact this employer? Yes No
Reason for Leaving:
3. Your Next Most Recent Employer: __________________________________________________________
Address: _______________________________________________________________________________
Phone: ________________________ Job Title: ________________________________________________
Number Supervised:_____________Supervisor’s Name: _________________________________________
From: ___/____/____ To: ___/___/___ Hour Per Week: __________ Salary: _________________________
May we contact this employer? Yes No
Reason for Leaving:
s
Town of Jackson, SC An Equal Opportunity Employer
APPLICATION FOR EMPLOYMENT
TOWN OF JACKSON
106 MAIN ST. / P.O. BOX 369
JACKSON, SOUTH CAROLINA 29831
4. Your Next Most Recent Employer: __________________________________________________________
Address: _______________________________________________________________________________
Phone: ________________________ Job Title: ________________________________________________
Number Supervised:_____________Supervisor’s Name: _________________________________________
From: ___/____/____ To: ___/___/___ Hour Per Week: __________ Salary: _________________________
May we contact this employer? Yes No
Reason for Leaving:
5. Your Next Most Recent Employer: _______________________________
Address: ________________________________________________________________________________
Phone: ________________________ Job Title: __________________________________________________
Number Supervised:_____________Supervisor’s Name: __________________________________________
From: ___/____/____ To: ___/___/___ Hour Per Week: __________ Salary: __________________________
May we contact this employer? Yes No
Reason for Leaving:
6. Your Next Most Recent Employer: _________________________________________________________
Address: ________________________________________________________________________________
Phone: ________________________ Job Title: _________________________________________________
Number Supervised:_____________Supervisor’s Name: __________________________________________
From: ___/____/____ To: ___/___/___ Hour Per Week: __________ Salary: __________________________
May we contact this employer? Yes No
Reason for Leaving:
APPLICATION FOR EMPLOYMENT
TOWN OF JACKSON
106 MAIN ST. / P.O. BOX 369
JACKSON, SOUTH CAROLINA 29831
5. ADDITIONAL INFORMATION:
Do you possess a valid driver’s license? Yes No
If so, list state ____________________________ Driver’s License Number:_________________________
Class of License: ___________________________
Do you have any relatives employed with the Town of Jackson? If yes, please provide names below:
Name: ______________________ Relation: _________________ Dept. ___________________________
Have you ever been convicted of a criminal offense? Yes No
Note: Omit minor vehicle violations and any offense committed before your 17
th
birthday, which was adjudicated in juvenile court
under a youthful offender. Conviction of a criminal offense is not a bar to employment in all cases. Each conviction is evaluated
individually.
If yes, please list charge(s): _________________________________________________________________
_______________________________________________________________________________________
Place of Conviction: _______________________ Date: ____________
Disposition/Status: ________________________
Have you ever been terminated or forced to resign from any job? Yes No
If yes, explain:
Are you legally authorized to work in the United States? Yes No
Give the names of three people, not relatives, who are familiar with your work.
Name: __________________________________ Phone Number: ___________________________________
Name: __________________________________ Phone Number: ___________________________________
Name: __________________________________ Phone Number: ___________________________________
Town of Jackson, SC An Equal Opportunity Employer
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