GARCA - Employment Form

Employment Application
GARFIELD COUNTY

114 W. BROADWAY

ENID, OK 73701

NOTICE TO ALL APPLICANTS: It is the policy of Garfield County to provide equal opportunities for employment, retention, transfer, and reassignment, advancement, and rehire of all persons regardless of age, race, color, creed, national origin, political affiliation, religion, physical/mental disability, or gender. Garfield County is a drug-free workplace. Candidates offered employment are required to pass a drug and/or alcohol test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Date

MonthDayYear
Personal Data:
Name

First NameMiddle NameLast Name
Permanent Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone Number:
Email*
Employment Preferrence:

Full-TimePart-TimeTemporary
Position applying for:

Assessor's officeField deputyOffice deputy
If you chose "Other", please specify the position's name.

Education:
High School:
Name
High School:
Grade Completed
College:
Name
College:
Grade Completed
Other:

Employment History:

Please list a complete record of your experience.

Employment 1
Business Name:
Job Title:
Business Addresss:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor:

First NameLast Name
May we contact?

YesNo
Reason for leaving:
Telephone:
Duration:
From
To
Beginning Pay:
From
To
Duties:

Employment 2
Business Name:
Job Title:
Business Addresss:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor:

First NameLast Name
May we contact?

YesNo
Reason for leaving:
Telephone:
Duration:
From
To
Beginning Pay:
From
To
Duties:

Employment 3
Business Name:
Job Title:
Business Addresss:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor:

First NameLast Name
May we contact?

YesNo
Reason for leaving:
Telephone:
Duration:
From
To
Beginning Pay:
From
To
Duties:

For Clerical Applicants:
Clerical Skills / Computer Experience:

References:

List three persons not related to you, whom you have known at least one year.

Reference 1
Name:

First NameLast Name
Occupation:
Years Known:
Phone Number:

Reference 2
Name:

First NameLast Name
Occupation:
Years Known:
Phone Number:

Reference 3
Name:

First NameLast Name
Occupation:
Years Known:
Phone Number:

Notice to Applicant:

I understand that as this County deems necessary, I may be required to work overtime hours or hours outside a normally defined work day or work week. If employed, I understand and agree that such employment may be terminated at any time for any reason not prohibited by law and without any liability to me for any continuation of salary, wages, or employment related benefits (not required by law).

I understand that my application will remain active one (1) year from date of application and that I should notify the Personnel Office, in writing, if I wish to be considered beyond that period.

I certify to the best of my knowledge the facts set forth in my application are accurate and complete.
Legal Signature of Applicant

Clear
Date

MonthDayYear
Please Note: Completion of the application DOES NOT GUARANTEE AN INTERVIEW OR EMPLOYMENT with Garfield County. Your application will be placed in an active file for one (1) year from the date completed. We will need to be notified of any changes on the application throughout the year.

Authorization to Release Information for Employment:
Applicant's Name:

First NameLast Name
Current Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
To whom it may concern:

I am an applicant for employment with Garfield County. This agency needs to thoroughly investigate my background and personal history to evaluate my qualifications to hold the position for which I applied. It is in the public's interest that all relevant information concerning my personal and employment history be disclosed to the above agency. Additional background information may be requested for specific positions.

I hereby request and authorize you to release to Garfield County any and all information or records concerning me, my background and personal history, my employment, education, military service, or criminal history. The intent of this authorization is to give my consent for full and complete disclosure of any and all information or records, including photocopies, whether private, public, confidential, or privileged, and to include the contents of investigatory files, evaluations, or rating complaints or grievances filed against me.

A photocopy or FAX copy of this release will be valid as an original thereof, even though the said photocopy or FAX copy does not contain an original writing of my signature.

I agree to indemnify and hold harmless any person to whom this request is presented and his agents and employees from and against all claims, damages, losses and expenses, arising out of or by reason of complying with this request.

Failure to release the information requested may result in the discontinuance of the background investigation and the processing of my application.

For and in consideration of Garfield County acceptance and processing of my application for employment, I agree to hold the Agency, its agents and employees harmless from any and all claims and liability associated with my application for employment or in any way connected with the decision whether or not to employ me. I understand that should information of a serious criminal nature surface as a result of this investigation, such information may be turned over to the proper authorities.

This authorization is valid for one (1) year from the date of my signature.
Signature

Clear
Date

MonthDayYear
Subscribed and sworn to before me this day of .
Notary Public Commission Number:
Expires:

Drug and/or Alcohol Testing Consent Form
In connection with my offer for employment with Garfield County, I hereby agree as follows:

I have applied for employment with Garfield County. As a condition of my employment being considered, I understand and agree to undergo drug and/or alcohol screening. I understand that I will be provided a copy of the drug and alcohol screening policy, and I further understand that if my test results are positive, I shall not be considered further by Garfield County for employment.

I hereby authorize any physician, laboratory, hospital, or medical professional retained by the County for screening purposes to conduct such screening and to provide the results to the County, and I release the County and any person affiliated with Garfield County and any such institution or person conducting the screening, from liability thereof.

Garfield County shall be entitled fully to rely on this Consent Form. I understand that I have no guarantee of employment and that the County may determine not to hire me for any lawful reason.
Applicant
Printed Name:
Date

MonthDayYear
Signature:

Clear
Garfield County
Printed Name/Title
Date

MonthDayYear
Employer Representative Signature:

Clear
Should be Empty:

Employment Application

Personal Data:

General Information:

If yes, give type, license number, and expiration date.

Education:

Employment History:

For Clerical Applicants:

References:

Notice to Applicant:

Authorization to Release Information for Employment:

Drug and/or Alcohol Testing Consent Form

Applicant

Garfield County