Fillable APPLICATION FOR EMPLOYMENT (State of Iowa - OCIO)

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APPLICATION FOR EMPLOYMENT (State of Iowa - OCIO)

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  • 24 check-boxes
  • 76 other fields

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U.S.A. forms for State of Iowa - OCIO

BROWSE STATE OF IOWA - OCIO (IA) FORMS

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Design Date: 7/19/2010; Revised Date 01/03/2014
APPLICATION FOR EMPLOYMENT
Buchanan County is an equal opportunity employer and does not discriminate on the basis of race, religion, color, national origin,
age, sex, gender, disability, or any other characteristic protected by law.
INTRODUCTORY INFORMATION:
Name: _____________________________________________________________________ Date: _____________________
Address: _________________________________________City: __________________State: __________ Zip: ___________
Phone: ___________________________ Social Security Number: ___________________
Do you possess an Iowa Driver’s License? Yes ___ No ___ DL# _____________________
Commercial Driver’s License (CDL) endorsement: Yes ___ No ___ Class___________
APPLICANT QUESTIONS:
Position applying for: ________________________ Salary desired: ________________ Date Available: _________________
Are you available for work: Full-Time Part-Time Temporary Seasonal
Are you 18 years of age or older? Yes No Are you a military Veteran? Yes No
Are you legally able to work in If Yes, Date of
the United States? Yes No Active Duty: From: ______________ To: ________
Have you ever been convicted of, pled guilty of, or no contest to a crime other than a minor traffic violation? Yes No
If yes, please explain in detail on a separate piece of paper and include the date of final disposition of the case and the nature of the offense. This
information will not necessarily disqualify you from employment but false or misleading information will. Factors such as age and time of the
offense, seriousness, nature of the violation, and rehabilitation will be taken into account.
Do any of your friends or relatives, work here? Yes ______ No _____ What Department: ___________________________
EDUCATION:
School or last grade completed:
Name/Address of School: _______________________________________________________________________________
Did you Graduate? Yes _____ No _____ Major Studies: _________________________________________
College or Technical School
Name/Address of School: _______________________________________________________________________________
Did you Graduate? Yes _____ No _____ Major Studies: _________________________________________
Other Schooling or Training
Name/Address of School: _______________________________________________________________________________
Did you Graduate? Yes _____ No _____ Years Attended/Major Studies: _____________________________
Special Qualifications (include technical and professional licenses, awards, etc.): ____________________________________
Other Training or Skills (Factory or Office Machines Operated, Special Courses, Computer Skills, etc.):__________________
____________________________________________________________________________________________________
RECORD OF EMPLOYMENT:
List employers, starting with the current or most recent (Explain all gaps in time of employment):
Employer: _____________________________________________________ Telephone: ____________________________
Address: ____________________________________________________________________________________________
Position Title:________________________________________ Supervisor: ______________________________________
Start Date:______________ Date Left:__________________ Beginning Salary:________________ Ending Salary: _______
Duties: _____________________________________________________________________________________________
Reason for Leaving:____________________________________________________________________________________
Design Date: 7/19/2010; Revised Date 01/03/2014
RECORD OF EMPLOYMENT (continued):
Employer: _____________________________________________________ Telephone: ____________________________
Address: ____________________________________________________________________________________________
Position Title: ___________________________________________Supervisor: ___________________________________
Start Date:______________ Date Left:__________________ Beginning Salary: _______________ Ending Salary: _______
Duties: _____________________________________________________________________________________________
Reason for Leaving: ___________________________________________________________________________________
Employer: ______________________________________________________Telephone: ____________________________
Address: _____________________________________________________________________________________________
Position Title:________________________________________ Supervisor: _______________________________________
Start Date:______________ Date Left:__________________ Beginning Salary: _______________ Ending Salary: ________
Duties _______________________________________________________________________________________________
Reason for Leaving: ____________________________________________________________________________________
Note to Applicant: DO NOT ANSWER THE FOLLOWING QUESTION(S) UNLESS YOU HAVE BEEN INFORMED ABOUT
THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job
or occupation for which you have applied? Yes No
A copy of the job description or occupation has been given? Yes No
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
___
WORK-RELATED REFERENCES: (Do not include relatives)
Name Occupation Years Known Contact Information
1. _________________ ______________________ ___________ _____________________________________
2. _________________ ______________________ ___________ _____________________________________
3. _________________ ______________________ __________ _____________________________________
STATEMENT (Please read this statement carefully before signing this application):
I understand that employment with Buchanan County is at-will, meaning that the County or I may terminate my employment at any
time, or for any reason consistent with applicable state or federal law.
I authorize the County to conduct a thorough background investigation of my work and personal history, and verify all data given on
this application and during interviews. I hereby release the County, and its representatives or agents, from any liability that might
result from such an investigation. I authorize all individuals, schools, and firms named to provide any requested information and
release them from all liability for providing the requested information.
I understand that any offer of employment with the County will be contingent on passing a job-related physical examination, and/or
successful completion of a drug and/or alcohol test as a condition of employment.
I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States,
and that federal immigration laws require me to complete an I-9 Form in this regard.
Have you ever been known by any other name(s) that the county will require to verify any of the information on this application?
_____________________________________________________________________________________________________
I understand this application will be active for a period of 90 days; after that time, if I wish to be considered for
employment, I must submit a new application. I certify that all the statements in this completed application are true
and
understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire.
Signature of Applicant: _______________________________________ Date Signed: ________________________________
OFFICE USE ONLY
DATE APPLICATION RECEIVED: _______________________ TIME RECEIVED: _____________ A.M./P.M.
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APPLICATION FOR EMPLOYMENT (State of Iowa - OCIO)

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Completed 29 October 2020

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