Fillable EMPLOYMENT APPLICATION (City of Sumter)

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EMPLOYMENT APPLICATION (City of Sumter)

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U.S.A. forms for City of Sumter

BROWSE CITY OF SUMTER (SC) FORMS

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EMPLOYMENT APPLICATION
AN EQUAL OPPORTUNITIY EMPLOYER
The City of Sumter is a DRUG FREE Workplace. All applicants tentatively
selected for employment will be required to pass a PRE-EMPLOYMENT PHYSICAL
EXAMINATION and DRUG SCREEN.
Please print in ink or type
Date______________________________________________________________________
Position applying for ______________________________________________________________________________________ Department ________________________________________________________
PERSONAL INFORMATION
Name_______________________________________________________________________________________________________________________________________________________________________________
First Middle Last Birth Mo. Birth Day Last 4 digits SS#
Present Address __________________________________________________________________________________________________________________________________________________________________
Street City State Zip Code How long have you lived here?
Previous Address_________________________________________________________________________________________________________________________________________________________________
Street City State Zip Code
Phone number (Day)______________________________________________ (Evening)_____________________________________________ (Other/Cell)_______________________________________
Are you a current City of Sumter employee or Yes
have you worked for the City of Sumter in the past? No If so when? ________________ What Department? __________________________________________________________
Your name when employed Please list any relatives
(if different from present name) _______________________________________________ employed by the City of Sumter ____________________________________________________________
Do you have a valid Yes
driver’s license? No ____________________________________________________________________________________________________________________________________________________
License No. State Expiration Date Restrictions
Do you have a valid Yes
CDL driver’s license? No ____________________________________________________________________________________________________________________________________________________
License No. State Expiration Date Restrictions
Have you been convicted or entered a plea of no contest, or a plea of guilty to a crime(s) other than misdemeanors and summary offenses which have not been
annulled, expunged or sealed by court? Yes No
If yes, please
explain and give dates: ___________________________________________________________________________________________________________________________________________________________
NOTE: Conviction does not necessarily bar you from consideration for employment.
Have you ever been fired or asked to resign from a job? Yes No If yes, give date, name, address of employer, and reason (attach additional
sheets if necessary): ______________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________
(A firing or forced resignation does not automatically mean that you cannot be employed. The circumstances, time elapsed, and recent employment record will be considered.
However, failure to be completely honest and accurate about such circumstances may cause your application to be disqualified for employment.)
EDUCATION HISTORY (Complete based on requirements of this position)
High school Highest Grade
attended: _____________________________________________ Location: ____________________________________________________________________________ completed: _______________________
Do you have a high school diploma or an Yes Where received: _____________________________________________________________________________________________________
equivalency diploma (GED)? No
Indicate below the computer programs with which you are proficient:
E-mail Word Excel Access PowerPoint Publisher
NAME AND ADDRESS Degree Pending
Degree Completed
(B.A. etc) or
Certificate
Major and Minor
Fields of Study
College
Graduate Work
Other (i.e. business, secretarial, vocational, technical, military, etc.)
MAILING ADDRESS
Human Resources
P.O. Box 1449
Sumter, SC 29151
(803) 436-2661
Work History
Give a complete record of your employment history including part-time work, military service and volunteer experience. List all experiences in order, start
with your present or most recent position then working back. Describe your duties and responsibilities in each position thoroughly so that your experience
may be fairly evaluated. Additional experience forms are available if needed.
Use this space for any special qualifications and skills or additional information that you feel will help evaluate your application:
_____________________________________________________________________________________________________________________________________________________________________________________
Corrected number of May we contact your Yes If no, explain: _____________________________________________________________________
words per minute: Typing _____________________ present employer? No _____________________________________________________________________________________
I hereby affirm that all statements made herein are true and correct. I authorize investigation into all statements and references contained in this application. Said investigation may
include credit, driving, criminal background, references and other background checks. By applying for this job, I also authorize post-hire investigation into my credit, driving, and
criminal background. If investigation determines any untrue statements, I accept this as sufficient grounds for refusal to hire or dismissal. I also authorize current and former
employers to release information regarding my employment. I agree to submit myself for a pre-employment physical examination and drug test by a physician selected by the City,
and I understand that failure to meet the physical requirements or refusal to be examined may disqualify me from employment.
Applicant’s Signature: _____________________________________________________________________________________________________________________________ Date: _______________________________________________
Dates of Employment
____________________ to __________________
Mo./Yr.
Mo./Yr.
Full-time Part-time
If part-time,
hours per week
_________________
Description of duties
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Machines and
equipment used_________________________________________________________________________________________________
Job Title
Mailing Address (including zip code)
Name of employing firm
Name and title of your immediate supervisor:
___________________________________________________________
Supervisor’s Phone No.
___________________________________________________________
Reason for leaving: ____________________________________
___________________________________________________________
Your name when employed if different from present
_____________________________________________________________
Number of People you supervised:
Dates of Employment
____________________ to __________________
Mo./Yr.
Mo./Yr.
Full-time Part-time
If part-time,
hours per week
_________________
Description of duties
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Machines and
equipment used_________________________________________________________________________________________________
Name of employing firm
Job Title
Mailing Address (including zip code)
Name and title of your immediate supervisor:
___________________________________________________________
Supervisor’s Phone No.
___________________________________________________________
Reason for leaving: ____________________________________
___________________________________________________________
Your name when employed if different from present
_____________________________________________________________
Number of People you supervised:
Dates of Employment
____________________ to __________________
Mo./Yr.
Mo./Yr.
Full-time Part-time
If part-time,
hours per week
_________________
Description of duties
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Machines and
equipment used_________________________________________________________________________________________________
Job Title
Mailing Address (including zip code)
Name of employing firm
Name and title of your immediate supervisor:
___________________________________________________________
Supervisor’s Phone No.
___________________________________________________________
Reason for leaving: ____________________________________
___________________________________________________________
Your name when employed if different from present
_____________________________________________________________
Number of People you supervised:
Dates of Employment
____________________ to ________________
Mo./Yr.
Mo./Yr.
Full-time Part-time
If part-time,
hours per week
_________________
Description of duties
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Machines and
equipment used_________________________________________________________________________________________________
Mailing Address (including zip code)
Name of employing firm
Job Title
Name and title of your immediate supervisor:
___________________________________________________________
Supervisor’s Phone No.
___________________________________________________________
Reason for leaving: ____________________________________
___________________________________________________________
Your name when employed if different from present
_____________________________________________________________
Number of People you supervised:
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EMPLOYMENT APPLICATION (City of Sumter)

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Completed 16 July 2020

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