Fillable Walton County Board of Commissioners Employment Application (Walton County Board of Commissioners)

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Walton County Board of Commissioners Employment Application (Walton County Board of Commissioners)

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The Walton County Board of Commissioners Employment Application (Walton County Board of Commissioners) form is 5 pages long and contains:

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BROWSE WALTON COUNTY BOARD OF COMMISSIONERS (GA) FORMS

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Positions Applied For:
1. 3.
2. 4.
Walton County considers applicants for all positions without regard to race, color, religion, gender, national
origin, age or disability. Fill in all items thoroughly. Your answers determine whether you will be considered
for
this position. We cannot accept incomplete, undated or unsigned applications. Applications will only be
accepted for posted positions. Walton County is a DRUG FREE WORKPLACE!
PERSONAL DATA
Please print in black o
r
blue ink o
r
type
–
DO NOT use pencil.
Last Name: First Name:
Middle or
Maiden Name:
Street Address:
State:
Hom
e
P
h
o
n
e
: Busine
ss
Phone:
Cell Phone: Email
A
ddress:
Will
you accep
t
:
Check all that apply
Temporary Work Shift Work
Part Time Work Weekends/Holida
y
s
Are you legally eligible to work in the United States?
*Note: If offered employment you will be required to provide documentation to verify employment eligibility. Failure to provide the requested documentation may result
in a determination that the applicant is ineligible for employment in the United States.
Have you ever been employed by Walton County Government before? If YES, when and where?
Do
y
ou have an
relatives who are currentl
y
emplo
y
ed with Walton Count
y
Government?
If so,
g
ive name, relationship, and department in which the
y
are emplo
y
ed:
Walton County Board of Commissioners
Employment Application
303 South Hammond Drive, Suite 331 – Monroe, GA 30655
Email: hr.resume@co.walton.ga.us Website:
www.waltoncountyga.gov
Office: (770) 267-1329 Fax: (770) 267-1415 Job Line: (770) 267-1986
Do you have a Valid Driver’s License? License #
Class
State
*Note: Possession of a valid driver’s license is not an essential function of all employment offered by Walton County. Answering “No” to this question is not
necessarily a bar to consideration for employment.
Have you had any traffic violations in the past 3 years?
If yes, please indicate type of offense and dates:
Have you ever been discharged from employment because your work or conduct was not satisfactory?
If yes, please explain:
EDUCATION
Describe any specialized training, apprenticeship or skills:
State any additional information you feel may be helpful to us in considering your application:
REFERENCES: List three (3) persons, other than relatives, who have knowledge of your work experience:
Name Address
Phone Number
Name Address
Phone Number
Name Address
Phone Number
Check Highest Year Completed Diploma/Degree/Certification Course of Study
Elementar
y
School 5 6 7 8
High School 9 10 11 12
Undergraduate
Graduate
EMPLOYMENT EXPERIENCE
List the positions that you have held, starting with your most recent one. THIS SECTION MUST BE COMPLETED IN
DETAIL. You are encouraged to attach a resume if you wish, but reference to a resume in lieu of completing
this section cannot be accepted and will be considered incomplete. INCOMPLETE APPLICATIONS WILL NOT
BE SUBMITTED FOR CONSIDERATION. Under “duties” describe your job in sufficient detail so that we can
determine not only your tasks but also the level of responsibility. If you have had more jobs or wish to add more detail
to the “duties” section, complete a separate sheet in the same format and attach.
Name o
f
Organization or Firm:
From (Month/Year)
Address
:
City:
To
(
Month/Year
)
Telephone Number:
State: Zi
p
:
Total Time Emplo
y
ed
(
Years & Months
)
: Official Job Title:
Supervisor’s Name:
Specific Job Duties:
Hours Worked Per Week:
Specific Reason For Leaving:
Beginning Salary: $
Per: Endin
g
Salar
y
:$ Per :
BETWEEN THESE JOBS
(
IF APPLICABLE
)
: UNEMPLOYED IN-SCHOOL OTHER
Name o
f
Organization or Firm:
From (Month/Year)
Address
:
City:
To
(
Month/Year
)
Telephone Number:
State: Zip:
Total Time Em
p
lo
y
ed
(
Years & Months
)
: Official Job Title:
Supervisor’s Name:
Specific Job Duties:
Hours Worked Per Week:
Specific Reason For Leaving:
Beginning Salary: $
Per: Endin
g
Salar
y
:$ Per :
BETWEEN THESE JOBS
(
IF APPLICABLE
)
: UNEMPLOYED IN-SCHOOL OTHER
Name o
f
Organization or Firm:
From (Month/Year)
Address
:
City:
To
(
Month/Year
)
Telephone Number:
State: Zip:
Total Time Em
p
lo
y
ed
(
Years & Months
)
: Official Job Title:
Supervisor’s Name:
Specific Job Duties:
Hours Worked Per Week:
Specific Reason For Leaving:
Beginning Salary: $
Per: Ending Salary: $ Per :
BETWEEN THESE JOBS
(
IF APPLICABLE
)
: UNEMPLOYED IN-SCHOOL OTHER
Rev 9/2019
NOTE: If you are contacted for an interview and need special accommodations due to a disability, please
advise at that time as to the type of accommodation.
Name o
f
Organization or Firm:
From (Month/Year)
Address
:
City:
To
(
Month/Year
)
Telephone Number:
State: Zip:
Total Time Em
p
lo
y
ed
(
Years & Months
)
: Official Job Title:
Supervisor’s Name:
Specific Job Duties:
Hours Worked Per Week:
Specific Reason For Leaving:
Beginning Salary: $
Per: Endin
g
Salar
y
:$ Per :
BETWEEN THESE JOBS
(
IF APPLICABLE
)
: UNEMPLOYED IN-SCHOOL OTHER
Name o
f
Organization or Firm:
From (Month/Year)
Address
:
City:
To
(
Month/Year
)
Telephone Number:
State: Zi
p
:
Total Time Emplo
y
ed
(
Years & Months
)
: Official Job Title:
Supervisor’s Name:
Specific Job Duties:
Hours Worked Per Week:
Specific Reason For Leaving:
Beginning Salary: $
Per: Endin
g
Salar
y
:$ Per :
BETWEEN THESE JOBS
(
IF APPLICABLE
)
: UNEMPLOYED IN-SCHOOL OTHER
APPLICANT’S CERTIFICATION
A
ND
A
GREEMENT
I certify that the statements made by me on this application are to the best of my knowledge, true, complete and
correct. I understand that any misrepresentations or material omission of fact on this or any other document
required by Walton County, if employed, may be considered as constituting grounds for disciplinary measures,
including dismissal. I further understand that any offer of employment is subject to successful completion
of a drug screen and where necessary, other examinations and background investigations. Having applied
for employment with Walton County, I do hereby agree and do give my consent that any person, firm or
organization listed herein is authorized to furnish Walton County with personal or reference material
concerning my character, past employment or any other information they so request and release them from any
dama
g
es whatsoeve
r
fo
r
issuin
g
same.
Ma
y
we contact
y
ou
r
present emplo
y
er?
Y
ES NO
Y
ou must sign the certification and agreement to enable us to contact prio
r
employers, though we may not
contact your present employer.
The following information is sought only to assist the County in analyzing and
monitoring its recruitment process in compliance with Federal laws. The
information will be kept separately from your application form, and will not be
used in employment decisions.
Please check items that apply:
Asian Native Hawaiian or Pacific Islander
Black or African American Two or More Races
Hispanic or Latino White
Native American or Alaska Native
Female
Male
Position applied for:
How did you learn of this job opening?
State Employment Service Friend/Relative
Job Board Websites Walk-in
County Bulletin Board/
Website Other (explain)
NAME DATE
ADDRESS
HOME PHONE SS#
Walton County Board of Commissioners
Affirmative Action Form
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Walton County Board of Commissioners Employment Application (Walton County Board of Commissioners)

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Completed 18 June 2021

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