Fillable Form 136: APPLICATION FOR EMPLOYMENT

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Form 136: APPLICATION FOR EMPLOYMENT

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The Form 136: APPLICATION FOR EMPLOYMENT form is 4 pages long and contains:

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  • 30 check-boxes
  • 233 other fields

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File type: PDF

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HUMAN RESOURCES’ USE ONLY
Qualified/Meets MQ’s
Not Qualified/Does not meet MQ’s
Education
Experience
Late Submission
Incomplete/Unsigned/Illegible
Reviewed By: _____ Date: _______
SUPERIOR COURT OF FULTON COUNTY
OFFICE OF HUMAN RESOURCES
136
PRYOR STREET, SW, ATLANTA, GA 30303
WWW.FULTONCOURT.ORG
APPLICATION FOR EMPLOYMENT
The SUPERIOR COURT OF FULTON COUNTY welcomes your application. This application is an important and essential part of the
recruiting process. Please answer all questions completely and accurately. Any untrue or misleading answer(s) or concealment of any
fact(s) will constitute grounds for no further consideration of this application or immediate discharge at any time during employment that
such false or misleading answer(s) or concealment of any fact(s) are revealed. If more space is needed, attach additional sheets referring to
the applicable section of the application. You must complete the entire application even if a resume is attached. Failure to complete the
entire application may result in disqualification or rejection of the application. Please type or print legibly in ink.
1. Date:
2. POSITION(S) APPLIED FOR:
3. Last Name:
First Name:
Middle Initial:
Suffix:
4. Address: Apt#:
City:
Zip:
5. Phone:
6. Email:
7.
Driver’s License: (State) (Number) (Class) (Expiration Date)
8.
Type of Work: What type of work will you accept?
Check all applicable types:
Regular/Permanent (Full-Time)
Temporary (Full-time)
Shift/Rotating Shift Work
Regular/Permanent (Part-Time)
Temporary (Part-Time)
Seasonal
8b. Work Location: Are you willing to work at any of our court facilities?
YES NO
9.
How much notice will you require to report to work
?
10.
Usually over a period of time the duties and responsibilities of a position will change, which may incorporate the use of technology, changes in the
function of the department or in the clientele group serviced by a department. Do you agree to accept material changes in the duties and
responsibilities of your position if hired? YES NO
11.
Employment Eligiblity Verification: After employment, can you submit verification of your legal
right to work in the United States? YES NO
Are you at least 18 years of age?
YES NO
12.
Court Employment:
Are you currently working or have you ever worked for Superior Court
or Fulton County Government?
YES NO | If YES, please
provide current or former position title, department and dates of service:
Do you have any relatives (by blood or marriage) employed by Superior
Court or Fulton County?
YES NO | If YES, please provide
the name, relationship, and business unit/location:
13.
Military Service: Have you ever served on active duty with the U.S.
Armed Services? YES NO
If YES, what branch: _____________________________________________
Highest rank attained: ____________________________________________
Type of discharge: _______________________________________________
(less than honorable discharges do not necessarily bar employment)
Was duty only as a reservist, where active duty was for six months or less?
YES NO
14.
Are you currently receiving retirements benefits
?
If YES, indicate agency retired from: ____________________________
15.
Can you perform the essential functions of the job with or without
reasonable accommodations? YES NO
16.
Language Skills: Indicate languages in which you possess sufficient fluency to act as an interpreter.
FULTON COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER
Clear Form
NAME: ________________________________________________________
Superior Court of Fulton County – Employment Application: Revised 2016
17. Education and Training: Please review the minimum qualifications section on the job announcement before completing this section.
HIGH SCHOOL
Name and Location
Did You Graduate?
Equivalency Test or GED?
Yes No Yes No
COLLEGE, UNIVERSITY, BUSINESS, TRADE, OR SERVICE SCHOOLS
Name and Location Degree Major
Number of Credits
Completed or Earned
Degree Type
(BS, BA AA, JD, PhD)
Dates of
Attendance
and/or Year
Degree Issued
Semester Units Quarter Units
PROFESSIONAL LICENSES, REGISTRATION, CERTIFICATIONS
Organization
License Number
(if applicable)
Issue Date
Expiration Date
PROFESSIONAL EXPERIENCE
18. Professional Experience: This is a very important part of the application process. Please provide a record of your professional employment history, starting
with your present or most recent position to include a work history of up to 10 years. A notation of “see resume/see attached” is not acceptable and will not be
used for evaluation purposes. Resumes may be attached, but they will not be accepted in place of a properly completed application for employment.
Employer:
Job Title:
From (Month/Year):_________________
To (Month/Year): ___________________
Total: _____Years _______Months
Hours per Week:
Address:
Supervisor’s Name/Title:
Phone Number:
# of Employees you supervised: Reason you Left or Wish to Leave:
Salary: $ per
Duties:
Employer:
Job Title:
From (Month/Year):__________________
To (Month/Year): ___________________
Total: _____Years _______ Months
Hours per Week:
Address:
Supervisor’s Name/Title:
Phone Number:
# of Employees you supervised
:
Reason you Left or Wish to Leave:
Salary: $ per
Duties:
Employer:
Job Title:
From (Month/Year): __________________
To (Month/Year): ____________________
Total: _____Years ______Months
Hours per Week:
Address:
Supervisor’s Name/Title:
Phone Number:
# of Employees you supervised:
Reason you Left or Wish to Leave:
Salary: $ per
Duties:
NAME: ________________________________________________________
Superior Court of Fulton County – Employment Application: Revised 2016
Employer:
Job Title:
From (Month/Year):__________________
To (Month/Year): ___________________
Total: _____Years ______Months
Hours per Week:
Address:
Supervisor’s Name/Title:
Phone Number:
# of Employees you supervised:
Reason you Left or Wish to Leave:
Salary: $ per
Duties:
Employer:
Job Title:
From (Month/Year):__________________
To (Month/Year): ____________________
Total: _____Years ______Months
Hours per Week:
Address:
Supervisor’s Name/Title:
Phone Number:
# of Employees you supervised:
Reason you Left or Wish to Leave:
Salary: $ per
Duties:
19. Additional Information: Please use this space for any additional information pertaining to your qualification or experience, explaining any GAPS in your
employment history. Please indicate the number of the item(s) in the application to which you are referring. You may attach additional sheet(s) if necessary.
20. Professional References: Please provide all of the requested information for three (3) professional references, must include at least (1) former supervisor.
21. Have you ever been discharged or asked to resign from any position? Yes No If YES, please provide details in the section below.
22. CERTIFICATION:
(Please read the application and your answers carefully before signing)
I understand and certify that all information given in this application is true and correct to the best of my knowledge and belief. I understand that any untrue or
misleading answer or concealment of any fact will constitute grounds for no further consideration of this application or immediate discharge at any time during
employment that such false or misleading statement or concealment of any such facts are revealed. All offers of employment are contingent upon the successful
completion of reference checks, criminal records verification and/or drug screening results. I hereby authorize Superior Court of Fulton County to verify, at
any time, any information contained in this application.
____________________________________________________________ ________________________________________
Signature of Applicant Date
PROFESSIONAL REFERENCES
NAME
TITLE
PHONE NUMBER
EMAIL ADDRESS:
click to sign
signature
click to edit
NAME: ________________________________________________________
Superior Court of Fulton County – Employment Application: Revised 2016
PROFESSIONAL EXPERIENCE ADDITIONAL PAGE
18b. Professional Experience: This is a very important part of the application process. Please provide a record of your professional employment history, starting
with your present or most recent position to include a work history of up to 10 years. A notation of “see resume/see attached” is not acceptable and will not be
used for evaluation purposes. Resumes may be attached, but they will not be accepted in place of a properly completed application for employment.
Employer:
Job Title:
From (Month/Year):__________________
To (Month/Year): ___________________
Total: _____Years _______Months
Hours per Week:
Address:
Supervisor’s Name/Title:
Phone Number:
# of Employees you supervised:
Reason you Left or Wish to Leave:
Salary: $ per
Duties:
Employer:
Job Title:
From (Month/Year):__________________
To (Month/Year): ___________________
Total: _____Years _______ Months
Hours per Week:
Address:
Supervisor’s Name/Title:
Phone Number:
# of Employees you supervised
:
Reason you Left or Wish to Leave:
Salary: $ per
Duties:
Employer:
Job Title:
From (Month/Year): __________________
To (Month/Year): ____________________
Total: _____Years ______Months
Hours per Week:
Address:
Supervisor’s Name/Title:
Phone Number:
# of Employees you supervised:
Reason you Left or Wish to Leave:
Salary: $ per
Duties:
Employer:
Job Title:
From (Month/Year):__________________
To (Month/Year): ____________________
Total: _____Years ______Months
Hours per Week:
Address:
Supervisor’s Name/Title:
Phone Number:
# of Employees you supervised: Reason you Left or Wish to Leave:
Salary: $ per
Duties:
Employer:
Job Title:
From (Month/Year):__________________
To (Month/Year):____________________
Total: _____Years ______Months
Hours per Week:
Address:
Supervisor’s Name/Title:
Phone Number:
# of Employees you supervised:
Reason you Left or Wish to Leave:
Salary: $ per
Duties:
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Form 136: APPLICATION FOR EMPLOYMENT

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Completed 28 December 2021

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