APPLICATION FOR EMPLOYMENT
County of Knox, Indiana an Equal Opportunity Employer
The County of Knox, Indiana, does not discriminate on the basis of race, color, gender, national origin, age, religion, or disability, in employment or the provision of services.
Please fill out responses to all questions on the application form. Any application not completed in its entirety will be disqualified.
Position Sought:
*
Name
*
First Name
Middle Initial
Last Name
Former Name:
Address:
*
City/State/Zip:
*
Phone:
*
Format: (000) 000-0000.
E-Mail:
*
example@example.com
Are you at least 18 years of age?
*
yes
no
Are you interested in:
*
Full-time
Part-time
Temporary
Date available to start work:
*
-
Month
-
Day
Year
Date
EMPLOYMENT HISTORY AND WORK EXPERIENCE
List all employment history and work experience during the previous five years, beginning with your current employer. Failure to include all past employment may be grounds for disqualification.
If currently unemployed.
Current Employer:
Address:
City/State/Zip:
Phone:
Format: (000) 000-0000.
Hire Date:
-
Month
-
Day
Year
Date
Job Title:
Supervisor:
Beginning Salary:
Current Salary:
Work Phone:
Format: (000) 000-0000.
Briefly describe the work you do, such as duties, responsibilities, equipment you operate, promotions:
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APPLICATION FOR EMPLOYMENT
Why do you want to leave?
May we contact your current employer?
yes
If no, please explain why:
Previous Employer:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone:
Format: (000) 000-0000.
Hire Date:
-
Month
-
Day
Year
Date
Job Title:
Supervisor:
Beginning Salary:
Ending Salary:
Work Phone:
Format: (000) 000-0000.
Briefly describe the work you do, such as duties, responsibilities, equipment you operate, promotions:
Reason for leaving?
May we contact your current employer?
yes
If no, please explain why:
If you had additional employers within the last five years, attach additional pages as needed. List and explain periods of unemployment in the past five years:
From:
To:
Reason:
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APPLICATION FOR EMPLOYMENT
From:
To:
Reason:
EDUCATION AND TRAINING
This section is intended to give the employer information about education and training you have completed, and to describe your skills, knowledge and abilities to perform the duties of the position.
High school attended
Attach additional pages as needed.
Name:
*
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Diploma?
*
yes
no
GED?
yes
no
College(s) or Trade School(s) attended
Attach additional pages as needed.
Name:
Dates attended:
to
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Degree:
Major/Minor course(s) of study:
Name:
Dates attended:
to
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Degree:
Major/Minor course(s) of study:
PERSONAL INFORMATION
Do you have any commitment which might interfere with or adversely affect your employment with us, such as a second job or school?
*
yes
no
If yes, please explain:
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APPLICATION FOR EMPLOYMENT
Have you ever been convicted of a felony?
*
yes
no
If yes, please explain:
Are you currently required to register as a sex offender in this or any other jurisdiction?
*
yes
no
If yes, please explain (including jurisdiction of registry):
Personal References
List three references who are
not
related to you and are
not
former employers or supervisors:
Name:
*
First Name
Last Name
Phone:
*
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of years known:
*
Name:
*
First Name
Last Name
Phone:
*
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of years known:
*
Name:
*
First Name
Last Name
Phone:
*
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of years known:
*
APPLICANT CERTIFICATIONS
Read each of the following paragraphs carefully. Indicate your understanding of, and consent to, the contents and conditions of each paragraph by signing your initials at the end of each paragraph. If you have any questions regarding these paragraphs, contact the employer
before
initialing.
I understand and accept that, if I am hired, I may be hired conditional on passing any medical and/or psychological examinations that the employer deems necessary to determine my ability to perform the essential functions of the position. I understand and accept that this may include drug, alcohol or substance abuse testing. Initials:
*
Initials
I understand that it may be necessary for me to approve and sign any waivers necessary in order for the employer to obtain information from my current and former employers.
*
Initials
I understand and accept that if any information required in this application is found to be falsified or intentionally excluded, my application may be disqualified from further consideration. I further understand and accept that, if I am employed by the employer, I may be subject to disciplinary action, including termination, if any information required by this application has been falsified or intentionally excluded.
*
Initials
I solemnly swear that all the information furnished in this employment application is true, accurate and complete to the best of my knowledge. I authorize investigation of all statements contained in this application. I understand that my misrepresentations or falsification of the information provided may lead to withdrawal of an employment offer or termination following employment.
*
Initials
By submitting this document, I hereby agree that I shall execute the employer's conditional and post-employment medical examination and drug testing consent requirements. I recognize that my future employment with the employer will be jeopardized if I engage in substance abuse, illegal drug use, or alcohol abuse.
*
Initials
Applicant's signature:
*
Date:
*
-
Month
-
Day
Year
Date
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