EMPLOYMENT APPLICATION
THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE EMPLOYEE AND THE
AGENCY. THIS DOCUMENT DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS. THE AGENCY RESERVES THE RIGHT
TO REVISE THE CONTENT OF THIS DOCUMENT, IN WHOLE OR IN PART. NO PROMISES OR ASSURANCES, WHETHER WRITTEN OR ORAL,
WHICH ARE CONTRARY TO OR INCONSISTENT WITH THE TERMS OF THIS PARAGRAPH CREATE ANY CONTRACT OF EMPLOYMENT.
Position applying for:
Job Title ____________________________________________________________________________________________________________________________
Agency __________________________________________________________________________________________ Location ___________________________
Contact Information
Name ___________________________________________________________________________________ Former Last Name ____________________________
First Middle Initial Last
Mailing Address ______________________________________________________________________________________________________________________
Address ____________________________________________________________________________________________________________________________
City County State Zip Code
Email Address _______________________________________________________________________________________________________________________
Home Phone_________________________________ Alternate Phone _______________________________ Notification Preference Mail Email
Other Personal Information
Do you possess a valid driver’s license? Yes No If yes, provide State and number: _____________________________________________________________
Expiration date __________________ Class (check one) A B C D E F M G
Can you, after employment, submit proof of your legal right to work in the United States? Yes No
Are you willing to relocate? Yes No If yes, provide counties _____________________________________________________________________
What type of job are you looking for? Regular Temporary Seasonal Internship
What types of work will you accept? Full Time Part Time Per Diem
What shifts are you available to work? Day Evening Night Rotating Weekends On Call (as needed)
Education
High School Name _____________________________________ Location _____________________________ Diploma Other (specify) ______________
Give name and address of school, major course of study, and degree achieved.
Undergraduate College/University ____________________________________ Graduate School ___________________________________________________
Degree Attained __________________________________________________ Degree Attained ____________________________________________________
Year ___________________________________________________________ Year _____________________________________________________________
Additional Information
Certificates and Licenses ________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Additional Skills ______________________________________________________________________________________________________________________
An Equal Opportunity Employer
EMPLOYMENT APPLICATION
Work History
Describe your work experience in detail, beginning with your current or most recent job. Include military service (indicate rank) and job related volunteer work, if
applicable. Provide explanation for any gaps in employment. All information in this section must be complete. A résumé may be attached, but not substituted for
completing this section. Should you need additional space, copy this page.
1. Name of Present or Last Employer: _____________________________________________________________________________________________________
Job Title: ___________________________________________________________________________________________________________________________
Address: _______________________________________________________________ Phone ____________________ Supervisor _________________________
From: ______ / _______ / ______ To: ______ / ______ / ______ Hours Per Week ________ Salary ______________ Number Supervised ______
May we contact this employer? Yes No
Job Duties (give details) ________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Reason For Leaving ___________________________________________________________________________________________________________________
2. Your Next Most Recent Employer: _____________________________________________________________________________________________________
Job Title: ___________________________________________________________________________________________________________________________
Address: _______________________________________________________________ Phone ____________________ Supervisor _________________________
From: ______ / _______ / ______ To: ______ / ______ / ______ Hours Per Week ________ Salary ______________ Number Supervised ______
May we contact this employer? Yes No
Job Duties (give details) ________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Reason For Leaving ___________________________________________________________________________________________________________________
3. Your Next Most Recent Employer: _____________________________________________________________________________________________________
Job Title: ___________________________________________________________________________________________________________________________
Address: _______________________________________________________________ Phone ____________________ Supervisor _________________________
From: ______ / _______ / ______ To: ______ / ______ / ______ Hours Per Week ________ Salary ______________ Number Supervised ______
May we contact this employer? Yes No
Job Duties (give details) ________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Reason For Leaving____________________________________________________________________________________________________________________
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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EMPLOYMENT APPLICATION
The following questions are strictly voluntary and will provide us with statistics needed to evaluate our
recruitment program, as well as prepare statistical reports required by Federal, State, and local agencies.
This information is not forwarded to hiring authorities.
GENDER
o Female
o Male
ETHNICITY
o American Indian/Alaska Native
o Asian
o Black/African American
o Hispanic/Latino
o Native Hawaiian/Other Pacific Islander
o Two or More Races
o White
DATE OF BIRTH
_______ / ________ / _________
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