Job Title
CITY OF CHARLESTON, SC
An Equal Opportunity Employer
Application for Employment
Instructions
This application must be completed in full and signed. Incomplete or unsigned applications will not be
considered. By filling out this application you are neither guaranteed an interview nor a job. The City
of Charleston is an employment at will organization and, therefore, the employer or employee can
terminate employment at any time without notice. Be aware that certain information contained in this
completed job application may be subject to the Freedom of Information Act. If you are selected for
an interview, you will be notified by the hiring department. All applicants are considered without
regard to color, race, sex, religion, age, national origin, marital status, veteran status or disability. If
you believe you have been discriminated against for these reasons on consideration of your
application, please notify the Director of Human Resources and Organizational Development, City of
Charleston, Human Resources Department-75 Calhoun Street, Suite 3600, Charleston, SC 29401. It
is also your right to notify the Equal Employment Opportunity Commission, Office of Federal Contract
Compliance Programs or any appropriate local or state agency of your complaint.
PERSONAL INFORMATION
Contact Infromation
First Name * Middle Initial Last Name *
Address 1 * City * State *
Zip Code * Cell Phone Number * Alt. Number *
E-mail Address Referred By
City Employee Referral
(name/dept)
Other
Referral Source
Have you ever been
employed with us before?
Yes No
If yes, give dates (from/to) Department Name
Do you have any relatives
employed here?
Yes No
If yes, provide name/dept.)
Relation
Are you able to provide proof that you are authorized to work in the United States? *
Ye
s No
Will you now or in the future require the City to commence (“sponsor”) an immigration case in
order to employ you (for example, H-1B or other employment-based immigration case)? This
is sometimes called “sponsorship” for an employment-based visa status. *
Yes No
Do you currently have any criminal charges pending other than speeding violations less than
10 miles over the limit? *
Yes No
If yes, please specify date(s) and nature of offenses
On what date would you be
available for work?
Immediately
After two week notice
Availability date
Are you willing to work (check all that apply)
Full-Time Part-Time Inclement Weather Temporary (no benefits)
Rotating Shifts Outdoors Weekends Holidays
EDUCATION HISTORY
High School
Highest Level of High
School Completed *
9 10 11 12
GED
Did you graduate? *
Yes No
General Information
High School Name * Location (City/State) * Degree Obtained/Major *
Trade School
Highest Level of Trade School
Completed
1 2 3 4
Did you graduate?
Yes No
Trade School Name and State Location (City/State) Degree Obtained/Major
Undergraduate School
Highest Level of
Undergraduate School
Completed
1 2 3 4
5
Did you graduate?
Yes No
Undergraduate School Name
and State
Location (City/State) Degree Obtained/Major
Graduate/Post-Graduate School
Highest Level of
Graduate/Post-Graduate
School Completed
1 2 3 4
5
Did you graduate?
Yes No
Graduate School Name and
State
Location (City/State) Degree Obtained/Major
CERTIFICATIONS
Professional or Trade Certifications
Name of Certification Issuing Organization Issue Date Expiration Date
Name of Certification Issuing Organization Issue Date Expiration Date
Formal Training
You may be required to provide verification.
Name of Training Presented By Date(s) Completed?
Yes No
Name of Training Presented By Date(s) Completed?
Yes No
EMPLOYMENT HISTORY
Employment Instructions
List jobs starting with your present or most recent job. Account for all employment/educational activity
within the last 7 years. Include any military experience.
Yes No
Telephone Number Job Title
Supervisor
Date Start Date End
Full-Time Part-Time
Rate - Starting Rate - Final
Reason for Leaving
Describe duties/list tools, equipment, and computer software utilized in this position.
Previous Employer
May we contact this
employer?
Yes No
Employer Address
Telephone Number Job Title
Supervisor
Date Start Date End
Full-Time Part-Time
Rate - Starting Rate - Final
Reason for Leaving
Most Recent or Current Employer
May we contact this employer?
Name of Employer
Address of Employer
Describe duties/list tools, equipment, and computer software utilized in this position.
Previous Employer
May we contact this
employer?
Yes No
Employer Address
Telephone Number Job Title
Supervisor
Date Start Date End
Full-Time Part-Time
Rate - Starting Rate - Final
Reason for Leaving
Describe duties/list tools, equipment, and computer software utilized in this position.
Previous Employer
May we contact this
employer?
Yes No
Employer Address
Telephone Number Job Title
Supervisor
Date Start Date End
Full-Time Part-Time
Rate - Starting Rate - Final
Reason for Leaving
Describe duties/list tools, equipment, and computer software utilized in this position.
SKILLS
Typing/Word Processing
Indicate the number of words per minute you
can type without error:
Computer Software
Check software that you are proficient in:
Windows Word Excel Powerpoint Access Outlook Internet
Other
Other Software
Driver's License
Do you have a valid driver's
license?
State of License Date of Expiration
Yes No
Do you have a valid commercial driver's license (CDL)?
No Permit Class A Class B
MILITARY SERVICE
Military Service
Have you served on active duty in the U.S. Armed Forces (any branch)?
Yes No
*If yes, please submit a copy of your undeleted discharge papers (DD214) which includes information
about your separation and characterization of the discharge to the Human Resources Department in
person, via fax at 843-579-7505 or upload them under the Additional Documents section on the left of
the screen. Did you receive an honorable discharge during all enlistments?
Yes No N/A
If you received any discharge other than honorable, please provide the specific type of discharge you
received and explain the reason for your discharge status.
APPLICANT STATEMENT
Applicant Statement
YOU MUST SIGN THIS APPLICATION. READ THE FOLLOWING CAREFULLY BEFORE YOU
SIGN.
I certify that all answers given herein are true and complete to the best of my knowledge. I authorize
any reference checks as well as the investigation of all statements contained in this application for
employment that may be necessary in arriving at an employment decision. In the event of
employment, I understand that false or misleading information given in my application or interview(s)
may result in discharge. If selected for employment, I further understand that my employment is
contingent upon passing a pre-employment physical, background investigation and/or drug test. I also
understand and acknowledge that all employees of the city are employees-at-will who may quit at any
time for any reason and who may be terminated at any time for any or no reason.
By attaching an electronic signature (whether typed, graphical or free form) I certify herein that I have
read and understood all the statements listed above and throughout the application form.
Required *
I Agree
Signature *
Date
AE2-2011
Referral Source:
EEO
Information
Not for Interviewing or Screening Purposes
Radio AdJob Service
Date of Application:
Newspaper Ad
Position(s) Applied For:
Telephone Number (s):
Zip Code:
Address State:
Address Number:
Street: City:
Name:
Please identify your race/ethnic category:
FemaleMale
American Indian or Alaskan Native
(original peoples of N. America who maintain cultural identification
through tribal affilation or community recognition.
Gender:
Vietnam Veteran
Check if any of the following are applicable:
Disabled Individual
Disabled Veteran
In accordance with Equal Employment laws, we are required to maintain statistical data on all applicants.
We ask for your cooperation in completing and returning the following information. This form will be
separated from your application and not used in the screening or interviewing processes.
Tv Ad/Cable City's Website Job Fair
Jobline Walk-in
Internet Site:
City Employee Referral:
Asian or Pacific Islander
(original peoples of the Far East, Southeast Asia, the Indian
Subcontinent of the Pacific Islands)
Hispanic
(all persons of Mexican, Puerto Rican, Cuban, Central or South
American or other spanish culture or orgin regardless of race)
Black (not of Hispanic orgin)
(all persons having origins in any black racial groups of Africa)
White (not of Hispanic orgin)
(all persons having origins in any of the original peoples of Europe,
North Africa or the Middle East)
I hereby authorize any city, county, state, or federal agency,
department or bureau to release any information in their files
under the above name. I understand and realize that the
information so released may prove unfavorable to me. I agree
to hold any source of information blameless for any error in
reporting this information. I further release all personnel
whomever from any liability arising out of or resulting from the
release of this information.
Signature of Applicant Date
NOTICE TO INDIVIDUALS WITH DISABILITIES, DISABLED VETERANS AND VIETNAM ERA VETERANS
Federal Government contractors are subject to Section 402 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative
action to employ and advance in employment qualified disabled veterans of the Vietnam Era; and section 503 of the Rehabilitation Act of 1973, as amended,
which requires the same of qualified disabled individuals. If you are a disabled veteran or have a physical or mental disability, you are invited to volunteer
this information. The purpose is to provide information regarding proper placement and appropriate accomodation to enable you to perform the job in a
proper and safe manner. This information will not adversely affect any consideration you may receive for employment.
If you wish to be identified, please check here
City of Charleston
DOB:
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