Fillable Application (Talbot County Government)

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Application (Talbot County Government)

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BROWSE TALBOT COUNTY GOVERNMENT (MD) FORMS

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Talbot C
ounty Government
Administrative Services
11 North Washington Street
Easton, MD 21601
Employment
Application
Instructions: Please read the official Job Description for complete job information and requirements
before filling out this application. Answer every question completely. Resumes or other kinds of
applications cannot be substituted for this official Talbot County Government Employment Application;
however, you may include a resume with this application if you wish. Please type or print clearly using
black ink. Please include your full name on any additional pages.
(P
LEASE PRINT)
Position(s) Applied For
Date of Application
Last Name
First Name
Middle Initial
Address
City
Zip Code
Home Phone Number
Cell Phone Number
E-mail address
D
o you have a valid Maryland driver’s license? Yes No
I
f you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No
H
ave you ever filed an application with us before? Yes No
I
f Yes, give date ________________
H
ave you ever been employed with us before? Yes No
If Yes, give date ________________
A
re you currently employed? Yes No
M
ay we contact your present employer? Yes No
A
re you prevented from lawfully becoming employed in the United States because of
Visa or Immigration Status? Yes No
Proof of citizenship or immigration status will be required upon employment
O
n what date would you be available for work? ________________
A
re you available to work: Full Time Part time Shift Work Temporary
A
re you currently on “lay-off” status and subject to recall? Yes No
Can you travel if the job requires it? Yes No
Did you graduate from high school? Yes No
Do you have a GED? Yes No
Name of School_____________________________________
Number:________________________________
City/State:_________________________________________
State:___________________________________
TALBOT COUNTY GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
EDUCATION
Name and location of college(s) or
university(ies) attended
Major Field Degree Type
Number of
Years Attended
Degree Rec’d
Yes/No
Other Training: Describe any specialized training (trade school, military training, law enforcement training, or specialized
schooling) you have received that may be relevant to this position. Include any licenses and certifications with numbers and
expiration dates, if available.
Trade School/Organization Name
Type of
Training
Describe
Certificate or
License
Expiration Date
SKILLS
Other Skills or Abilities: Please describe your proficiency/skill/ability in the use of computer hardware and software,
equipment/tools, or any other special skills or abilities that enhance your qualification for this position. Only include skills that
you currently use or have maintained, and identify how you use those tools.
Specific Skill or Ability
Specific Tool/Equipment/
Hardware/Software
Proficiency Level
(Advanced/Intermediate/Beginner)
How Used
(Application)
Please rate your computer skills in the following areas:
Microsoft Word
(None / Use Regularly / Very Skilled)
Microsoft Excel
(None / Use Regularly / Very Skilled)
Microsoft Outlook
(None / Use Regularly / Very Skilled)
Language Skills: Please describe your proficiency/skill in foreign or sign language as identified below. For skill level please
choose excellent, good or fair under reading, speaking, understanding and writing:
Language
Reading
(Excellent/Good/Fair)
Speaking
(Excellent/Good/Fair)
Understanding
(Excellent/Good/Fair)
Writing
(Excellent/Good/Fair)
MILITARY
Are you a veteran? Yes No Date Entered: ___________ Discharge Date: _______________
Branch/Duty/Specialized training:___________________________________________________________________
______________________________________________________________________________________________
PREVIOUS EMPLOYMENT
Start with your Present or Most Recent Job. Include all relevant paid, non-paid, volunteer and military experience. List
Promotions as Separate Jobs. You must provide all of the information requested for each job you list. If more space is required,
please attach additional pages that provide all of the information requested for each job. A resume should be used only to
supplement information presented here. Label all additional pages with your Name and the job for which you are applying.
Company:______________________________________ Address: _______________________________________
Job Title: _____________________________ Responsibilities: _________________________________________
______________________________________________________________________________________________
From: ______________ To: ______________ Reason for Leaving: ______________________________________
May we contact your previous supervisor for a reference? Yes No
Name of Supervisor:_____________________________________________ Phone: _________________________
Company:______________________________________ Address: _______________________________________
Job Title: _____________________________ Responsibilities: _________________________________________
______________________________________________________________________________________________
From: ______________ To: ______________ Reason for Leaving: ______________________________________
May we contact your previous supervisor for a reference? Yes No
Name of Supervisor:_____________________________________________ Phone: _________________________
Company:______________________________________ Address: _______________________________________
Job Title: _____________________________ Responsibilities: _________________________________________
______________________________________________________________________________________________
From: ______________ To: ______________ Reason for Leaving: ______________________________________
May we contact your previous supervisor for a reference? Yes No
Name of Supervisor:_____________________________________________ Phone: _________________________
PREVIOUS EMPLOYMENT
(Continued)
Company:______________________________________ Address: _______________________________________
Job Title: _____________________________ Responsibilities: _________________________________________
______________________________________________________________________________________________
From: ______________ To: ______________ Reason for Leaving: ______________________________________
May we contact your previous supervisor for a reference? Yes No
Name of Supervisor:_____________________________________________ Phone: _________________________
REFERENCES
Please list three professional references. If you are authorizing us to contact at least three previous supervisors
(Below), you may skip this section.
Name: _____________________________________________ Relationship: _________________________
Company: __________________________________________ Phone: ______________________________
Address: ______________________________________________________________________________________
Name: _____________________________________________ Relationship: _________________________
Company: __________________________________________ Phone: ______________________________
Address: ______________________________________________________________________________________
Name: _____________________________________________ Relationship: _________________________
Company: __________________________________________ Phone: ______________________________
Address: ______________________________________________________________________________________
If you need additional space, please continue on a separate sheet of paper.
Applicant’s Statement
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may
be necessary in arriving at an employment decision.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any
employment relationship with this organization is of an “at will” nature, which means that the
Employee may resign at any time and the Employer may discharge Employee at any time with
or without cause. It is further understood that this “at will” employment relationship may not
be changed by any written document or by conduct unless such change is specifically
acknowledged in writing by an authorized executive of Talbot County.
In the event of employment, I understand that false or misleading information given in my
application or interview(s) may result in discharge. I understand, also, that I am required to
abide by all rules and regulations of Talbot County.
____________________________________________ _____________________
Signature of Applicant Date
FOR DEPARTMENTAL USE ONLY
Arrange Interview Yes No
Remarks____________________________________________________________________________
___________________________________________ ______________________________
Interviewer Date
NOTES______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Rev. 9/2018
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Application (Talbot County Government)

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Completed 24 July 2020

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