EMPLOYMENT APPLICATION
Please carefully read the following information:
Have you ever been convicted of a criminal offense? Yes No
Note: Omit minor vehicle violations and any offense committed before your 17th birthday which was finally adjudicated in juvenile court or under a youthful offender
law. Conviction of a criminal offense is not necessarily an absolute bar to state government employment in all cases. Each conviction is evaluated individually.
If yes, please list charge(s) _________________________________________________________________________________________________________
Where Convicted____________________________________________________ Date _____________ Disposition/Status ____________________________
Are you currently employed by the State of South Carolina? Yes No If yes, which agency?_________________________________________________
Do you have any relatives employed with the State of South Carolina? Yes No If yes, please provide name(s), relationship, and agency below.
Name _____________________________________ Relationship ______________________ Agency _____________________________________________
Name _____________________________________ Relationship ______________________ Agency _____________________________________________
Have you ever been terminated or forced to resign from any job? Yes No If yes, please explain below.
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Have you been separated from South Carolina State Government employment as a part of a reduction-in-force within the past 12 months? Yes No
Give the name, address, and phone number of two people, not relatives, who are familiar with your work.
Name ___________________________________________ Address __________________________________________________ Phone ____________________
Name ___________________________________________ Address __________________________________________________ Phone ____________________
Student Loan: State Law (59-111-50) prohibits employment with the State to people who have defaulted on certain student loans, unless they can prove that satisfactory
arrangements have been made for repayment. By my signature, I certify that I am not currently in default on a student loan.
Signature _____________________________________________________ Date ______________________________
Authority to Release Information: By my signature, I consent to the release of information to authorized officers, agents, and employees of the State of South Carolina
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 any personnel record deemed necessary. In addition, I consent to authorize
appropriate officers, agents and employees of the State to make inquiries of third parties. I further release the organization, educational entity, present and former
employers, law enforcement organization, all third parties from any and all claims of whatever nature that I may have as a 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 information or data on this 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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