APPLICATION FOR EXAMINATION
Calhoun County Civil Service Board
Suite 115
1702 Noble Street
Anniston, AL 36201
USE THE TITLE FROM THE JOB ANNOUNCMENT
Last Name
First Name Middle Name
1)Job Applying For:
2)Your Name:
3)Address:
No. And Street
RD or PO Box APT. No.
4) How long have you lived at this address?
Years: Months:
City
State Abr. ZIP Code
5) Your Telephone Number:
Home Work
6) Date of Birth (MM/DD/YYYY) 7) Social Security Number 8) Have you ever been convicted of any
offense other than a minor traffic violation?
Yes No
Conviction is not necessarily
disqualifying. Give facts and
dates of your conviction(s) in
Space 9.
9) Use this space to explain any items in Spaces 1-8:
10) EDUCATION
A) Did you graduate from high school?
Month
Year
Highest Grade Completed
Yes
No
B) If you have a high school equivalency certificate, give year and place the certificate was granted:
Year
Place Granted
C) Give last high school, grade school or trade school you attended:
Name of School Location Dates Attended Course
D) List any colleges, business schools or technical schools you attended:
Name of School
Location
Course or Major
Dates Attended
Degree or Certificate Received
E) Other training (special courses, work training programs, armed forces training). Give name and location where training was given, certificate (if any), dates
attended, subject of training, number of hours weekly, and other details related to the job for which you are applying:
(See Next Page)
Fill in form using
Acrobat Reader or
print and
complete
in ink or on a
typewriter.
Voice Number: (256) 241-2940
11) EXPERIENCE: Start with your present or last job and work back listing all paid or unpaid, full or part-time work, military service, and summer jobs performed
during the last 10 years. Use additional sheets of plain paper if you need more space. Work performed more than 10 years ago may be given if it applies to the
job you want.
Is it O.K. if we contact your present employer?
Yes
No
(Note: We may contact any previous supervisor to verify your past duties.)
Starting Date:
Month Year
Ending Date:
Month
Year
Name and Address of Present or Last Employer:
Salary Hours per Week
Name, Title, and Phone Number of your immediate supervisor:
Reason for Leaving:
Your present or last job title:
Your duties:
Starting Date:
Month Year
Ending Date:
Month
Year
Name and Address of Present or Last Employer:
Salary Hours per Week Name, Title, and Phone Number of your immediate supervisor:
Reason for Leaving:
Your present or last job title:
Your duties:
Starting Date:
Month Year
Ending Date:
Month Year
Name and Address of Present or Last Employer:
Salary Hours per Week Name, Title, and Phone Number of your immediate supervisor:
Reason for Leaving:
Your present or last job title:
Your duties:
Starting Date:
Month Year
Month
Ending Date:
Hours per WeekSalary Name, Title, and Phone Number of your immediate supervisor:
Reason for Leaving:
Your present or last job title:
Your duties:
Name and Address of Present or Last Employer:
Year
(See Next Page)
12) SPECIAL SKILLS OR ABILITIES: Show licenses (including driver's); machines you operate; languages other than English which you speak, read and write well;
typing and shorthand speeds; and any other special abilities or knowledges relating to the job you are applying for:
CERTIFICATION: I certify that all statements made on or in connection with this application are true, complete, and correct to the best of my
knowledge and belief, and are made in good faith. I understand that incomplete, false, or inaccurate information may result in the rejection of
this application and that false information may result in my dismissal if employed.
Date
Signature
COMPLIANCE INFORMATION
The following information is needed for compliance with governmental selection requirements and for EEO reports. It will be detached
when your application is filed and the information on it will not be considered in the employment process:
1. Your Name:
2. Job Applied For:
3. Sex (Please check one)
Male
Female
4. Describe yourself in terms of one of the following groups. (Check one only)
A. American Indian
B. Black/Afro American
C. White/Caucasian
D. Hispanic/Spanish Sumamed
E. Oriental/Asian American
F. Other:
Please specify
Date:
** Note: Aliens must show an Alien Registration Receipt Card (Form I-151), Form I-94 endorsed to permit employment. **
I understand that positions within the County workforce require a background check. I hereby give County Officials permission to perform a
background check to include driving record and criminal history.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome