Application For Employment
Clark County Courthouse | 517 Court Street, Neillsville, WI 54456
Application Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Are you a US Citizen
*
Yes
No
If no, please list type of Visa
Are you at least 18 years of age?
*
Yes
No
If no, please indicate date of birth:
Position Information
Position Applying For
*
Date Available for Work
*
-
Month
-
Day
Year
Date
Type of Work Desired
*
Shift Desired
Current Salary (Required)
Where did you hear of this employment opportunity?
Shopper
Thorp Courier
Clark County Press
Tribune Phonograph
Job Center
TRG
Friend
Other
If other, tell us where?
Professional/Work Experience
The information regarding your previous experience will be carefully reviewed to determine your qualifications in relation to the position for which you are applying. Please be specific in your responses. Please include in the description of your duties any supervisory responsibilities and any equipment operated, if applicable. Please list information with most recent experience first. Please list any additional pertinent employment, not shown above, on a separate sheet.
Employer Section 1
Employer's Name
Supervisor Name and Title
May we contact this employer for a reference?
Yes
No
If no, please explain
Dates of Employment
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position (s) Held (if multiple, please indicate dates for each)
Type of Position Worked
Number of Employees Supervised?
Reason for Leaving
Duties Preformed
Employer Section 2
Employer's Name
Supervisor Name and Title
May we contact this employer for a reference?
Yes
No
If no, please explain
Phone Number
Please enter a valid phone number.
Dates of Employment
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position (s) Held (if multiple, please indicate dates for each)
Type of Position Worked
Number of Employees Supervised?
Reason for Leaving
Duties Performed
Professional Licenses or Certifications
List licenses or certificates along with type, state issued, expiration date, and license/registration number.
Education
Do you have a High School Diploma/HSED or GED?
Yes
No
Postsecondary Education
Type of School
Name and Location (City/State)
Course of Study
Year Completed
Did you Graduate?
Yes
No
Year Graduated
Diploma or Degree
Please List any Additional Postsecondary Education Here...
Additional Information
Please list all office machines, heavy equipment, or any other equipment related to the job you are applying for that you are skill in operating (i.e. personal computer, dictation equipment, front-end loader, etc.):
Do you possess a valid driver's license?
Yes
No
License Number and State of Issuance
Do you possess a valid commercial driver's license
Yes
No
If yes, please check all subclasses
Class A - Commercial Motor Vehicle
Class B - Commercial Motor Vehicle
Class C - Regular (Auto, Light, Moped)
Class M - Motorcycle
License Number and State of Issuance
Endorsements:
P - Transporting Passengers
T - Doubles and Triples
N - Tank Vehicles
S - School Bus
F - Farm Services
If you do not have one or either of these license, would you be eligible to obtain such a license if required by the position for which you are applying?
Yes
No
Please describe any additional job-related skills or abilities you may possess, which are not mentioned above. This information may include extracurricular activities, volunteer work, etc. Please indicate length of time involved with any groups or committees.
Reference 1
Please list three (3) references which are neither a relative nor a supervisor whom we may contact in regard to your qualifications
Name
First Name
Last Name
Occupation/Relationship
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Reference 2
Name
First Name
Last Name
Occupation/Relationship
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Reference 3
Name
First Name
Last Name
Occupation/Relationship
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
PLEASE READ CAREFULLY BEFORE SIGNING
I authorize Clark County, at the time of my application for employment or during the course of my employment, to obtain information from any source indicated regarding my education, experience, competence, character as it relates to the position for which I applied or in which I may be employed unless otherwise stated. I certify that the information contained in this application is true, complete and correct to the best of my knowledge and belief. I understand that any falsification or omission of information may cause my immediate dismissal or rejection of theapplication. I agree that all statements made may be investigated. I also understand that I may be required to successfully complete a medical exam for initial and continued employment.
By typing my name below I agree to all terms and conditions and submit my name as my digital signature.
Yes
No
Applicant Signature
Date
-
Month
-
Day
Year
Date
Attach Resume and Cover Letter (Files must be named "lastname.resume, lastname.coverletter")
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