Application For Employment
  • Application For Employment

  • DICKINSON COUNTY

  • 109 E. First Street Abilene, KS 67410

    We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.

    Completing an application does not imply that you will be interviewed or hired. If you are offered employment, it may be necessary to pass a physical examination and/or drug screen.

  • Personal Information

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  • Format: (000) 000-0000.
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  • Education

  • Rows
  • Rows
  • Military Service (If Applicable)

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  • References

    Please list three professional or personal references that are not related to you.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Employment History

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  • Past Employers

    List your work history for the past ten (10) years below, beginning with the present or most recent job. Emphasize your specific tasks, supervisory or technical responsibilities. Give special attention to experience related to the job for which you are applying.
  • Format: (000) 000-0000.
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  • Format: (000) 000-0000.
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  • Format: (000) 000-0000.
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  • Format: (000) 000-0000.
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  • Disclaimer and Signature

  • I hereby authorize Dickinson County to contact, obtain and verify the accuracy of information contained in this application from all previous employers, educational institutions and references. I also hereby release from liability Dickinson County and its representatives for seeking, gathering and using such information to make employment decisions and all other persons or organizations for providing such information.

    1 understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

    If I am employed, I acknowledge that there is no specified length of employmentand that this application does not constitute an agreement or contract for employment. Accordingly, either the employer or I can terminate the relationship al will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

    The employer is an equal opportunity employer. The employer does not discriminate in employment, and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state, or federal law.

    I understand that Dickinson County will not refuse to hire a qualified individual with a disability because of that person’s need for an accommodation that would be required by the ADA. 1 understand that 1 may be asked to undergo a pre-employment physical examination and/or drug screen, and I authorize the release of any job-related

    medical information from this examination/drug screen to Dickinson County. I understand that if this examination 'drug screen reveals the need for further examination, testing, or treatment, such further examination, testing, or treatment will be at my sole expense.

    I understand my driving record may be reviewed, and I understand I may be required to complete any pertinent testing (i.e. typing, ten key. written exams, physical ability’ testing) prior to offer of employment.

    Completing an application does not imply you will be interviewed or hired. If you are offered employment, it may be necessary to pass a background investigation, polygraph, physical examination and/or drug screen. Equal access to programs, services and employment is available to all persons. Those applicants requiring accommodation to the application and or interview process should contact a Human Resources representative.

    I also understand that if I am employed. I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

    I hereby represent that the information provided is correct and complete to the best of my knowledge. I understand that any incorrect, incomplete or false statements or information furnished by me may void this application or subject me to discharge any at any time after employment.

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