JASCO Application for Employment

Full Legal Name*

First NameLast Name

Today's Date

MonthDayYear

Social Security Number*

Phone Number*

Format: (000) 000-0000.

Driver's License Number*

Driver's License State*

Missouri/Arkansas/Kansas

E-mail*

example@example.com

Date of Birth*

MonthDayYear

Present Address*

Street Address

Street Address Line 2

CityState

Zip Code

How did you learn about the position?

Position Desired*

YesNo

When?

YesNo

When?

Reason for leaving

YesNo

Date you can start*

MonthDayYear

Full TimePart TimeShift Work

Salary Desired

YesNo

If yes, please describe the offense(s) below.

YesNo

If yes, please explain.

YesNo

Describe any job-related training received in the United States Military.

YesNo

Name of high school attended

Years attended

City

State

Subjects studied

YesNo

YesNoAre you currently enrolled in College?

Name of college attended

Years attended

City

State

Subjects studied

YesNo

Name of school attended

Years attended

City

State

Subjects studied

YesNo

Please list and describe any other education not listed above.

Indicate any foreign languages you can speak, read and / or write. Please indicate if you are fluent, good, or fair in each language.

Describe any specialized training, apprenticeship, skills and extra-curricular activities that relate to this position.

List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:

Begin with your present or most recent job. List all jobs, paid or volunteer, civilian and military over the past ten years. A resume may be attached to provide additional or more detailed information, but will not be accepted in lieu of completing this section. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. DO NOT WRITE “SEE RESUME” IN SPACES BELOW. Any break for more than 1 month in employment with in the last 10 years must have a written explanation for verification.

YesNo

Give the names of 3 people not related to you, whom you have known for at least 1 year.

Full Name*

First NameLast Name

Phone Number*

Format: (000) 000-0000.

Years Known*

How do you know this person?*

Full Name*

First NameLast Name

Phone Number*

Format: (000) 000-0000.

Years Known*

How do you know this person?*

Full Name*

First NameLast Name

Phone Number*

Format: (000) 000-0000.

Years Known*

How do you know this person?*

I certify that answers given herein are true and complete to the best of my knowledge. They are made voluntarily upon application for employment, and as inducement therefore. In the event that any information on this application is found to be untrue, the applicant may become disqualified from the process or if employed, may be dismissed from employment immediately.

I authorize Jasper County Emergency Services to investigate all statements contained in this application for employment as they may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such charge is specifically acknowledged in writing by an authorized executive of this organization.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

In the event of employment, I understand that false or misleading information given in my application or interview (s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

After completing this application, you will receive an email with instructions to complete. Failure to complete the steps listed in the email may result in the dismissal of your application.

I do hereby release all parties and individuals connected therewith from all liabilities for any damage whatsoever incurred in furnishing such information.

I agree

Signature*

Upload your resume (Optional)

Please verify that you are human*

Application for Employment

Personal Information

Education

Employment Experience

References

Acceptance and Signature