1
2
3
4
5
6
7
8
9
10
11

Enter Information for Job Application


Personal Information (Page One)

Name



Address









Personal Information (Page Two)

Background

Education (Page One):

Elementary


High School




Education (Page Two):

College/University





Graduate/Professional





Employment (Page One):

Employer #01

















Employer #02














Employment (Page Two):

Employer #03















Employer #04















Person References

Person References (Not former employees or relatives)








Please Read Carefully Before Signing
I understand that all appointments are probationary for a period of six months. during which time I must demonstrate my fitness for continued employment. I also understand that all appointments offered me will be contingent upon the results of a complete character and fitness investigation. I am aware that willfully withholding information or making false statements on the application will be a basis for denial of a position prior to employment, or will be grounds for dismissal after appointment. I agree that this application and all other papers shall be confidential records of the Personnel Board subject to inspection by the appointing authority. I hereby certify that all statements are true and correct to the best of my knowledge.





Person References

Authorization and Release
A FALSE STATEMENT ON ANY PART OF YOUR APPLICATION MAY BE GROUNDS FOR NOT HIRING YOU, OR FOR TERMINATION OF YOUR EMPLOYMENT AFTER YOU BEGIN WORK.

I understand that any information I give may be investigated as allowed by law. I consent to the release of information about my ability and fitness of employment with Houston County by law enforcement agencies, employers, schools, and other individuals and organizations, to personnel staffingspecialists, and other authorized employees of Houston County. I certify that to the best of my knowledge and belief, all of my statements on employment applications and related employment papers are true, correct, and complete, and made in good faith.I hereby release the aforementioned person T corporations, agencies, associations and their employees, agents and representatives from any and all liability for damages of what ever kind of nature which may at any time result to me on account of compliance with this authorization.A copy of this authorization shall be effective and valid as the original.


Attention: Applicants having military experience should also read and sign the following statement: I authorize the National Personnel Records Center, St Louis, MO or other custodian/s of my military record to release to the Houston County Personnel Board, information or photocopies form my military personnel and related medical records, or only the following informationlrecords:



Person References:

***Special Condition



Military Service Record









***Special Condition


Equal Employment Opportunity

 
EEO REPORTING DATA