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DAWSON COUNTY GOVERNMENT EMPLOYMENT APPLICATION www.dawsoncountyga.gov Applications may be emailed to: [EMAIL REDACTED] delivered or mailed to: Human Resources Department 25 Justice Way, Suite 2233 Dawsonville, GA 30534 Last Name First Middle Date of Application Apartment/Unit # PO Box State Zip Code Home Telephone Cell/Other Phone Date available for employment Salary Desired Branch Type of Discharge City State Did you graduate? Yes No City State Did you graduate? Yes No City State Did you graduate? Yes No City State Did you graduate? Yes No Degree/Specialty: Special courses or certifications which relate to the position you are applying for: Trade (or Apprentice) School Degree/Specialty: College or Business School Degree/Specialty: College or Business School MILITARY Dawson County Government is an Equal Opportunity Employer Dawson County Government is a Drug Free Employer NOTE: All fields must be answered fully in order to be considered for employment. Application must be typed or completed in ink. Please ask for assistance if any portion of the application is unclear. APPLICANT INFORMATION Highest Rank Obtained Have you ever been previously employed by Dawson County Government? Yes No If yes, when? Position Desired Are you a citizen of the United States? Yes No If No, are you authorized to work in the U.S? Yes No Note: If offered employment, you will be required to provide documentation to verify employment eligibility. Failure to provide the requested documentation may result in a determination that the applicant is ineligible for employment in the United States. Street Address City Email Address High School EDUCATION Highest Grade Completed? GED Are you currently employed? Yes No May we inquire of your present employer? Yes No Do you have any family members or relatives who work for Dawson County Government? If served in the Military, please include a copy of your DD214 1 (Please provide a copy of all certifications and degrees listed.) Yes No If yes, please list name and department: Position held? Rev. 10/04/23 ---PAGE BREAK--- Telephone Number Supervisor City/State Zip Code Telephone Number Supervisor City/State Zip Code Telephone Number Supervisor City/State Zip Code Telephone Number Supervisor City/State Zip Code Telephone Number Supervisor City/State Zip Code Company Name Reason for Leaving: Describe your duties: Reason for Leaving: Company Name Street Address FORMER EMPLOYMENT Street Address Employment Dates: (Start - End) Describe your work history for the past (10) years and any relevant work history regardless of age, beginning with your current or most recent job. Include volunteer experience and periods of unemployment. All fields with the exception of "Supervisor," are required. Failure to complete all required fields of information for each job held may result in disqualification. Attach additional sheets if necessary. A resume may be attached only as additional information and will not be accepted in lieu of completing this section. Company Name Describe your duties: Employment Dates: (Start - End) Street Address Describe your duties: Reason for Leaving: Street Address Describe your duties: Describe your duties: Reason for Leaving: Company Name Reason for Leaving: Company Name Street Address Position Held Position Held Employment Dates: (Start - End) Employment Dates: (Start - End) Position Held Employment Dates: (Start - End) Position Held Position Held 2 ---PAGE BREAK--- City/State/Zip Telephone City/State/Zip Telephone City/State/Zip Telephone City/State/Zip Telephone Applicant's Signature Date County Job Board Email REFERENCES List the name, address, email, and telephone number of four professional references. Do not list relatives. All listed references will be contacted. Referred by: County Website Newspaper Indeed REFERRAL SOURCE Other Website: Please list: DRUG FREE WORKPLACE ACKNOWLEDGEMENT As a condition of employment with Dawson County Government, you will be required to submit to an alcohol and controlled substance test. In order to be employed by Dawson County Government, you must successfully pass this screening test. Candidates rejected for failing to pass the required screening will be required to wait at least 12 months before reapplying for employment. Employees must, as a condition of employment, abide by the Dawson County Substance Abuse/Drug Testing Policy. Employees who are indicted for or convicted of a controlled substance related violation under state or federal law, or who plead guilty or no contest to such charges must inform their Supervisor or Human Resources in writing within five days of the conviction or plead (this is a requirement of the Drug Free Workplace Act of 1988). Should you be offered a job with Dawson County Government, your position will be subject to post accident and reasonable suspicion testing. All safety sensitive positions will be subject to random drug and alcohol testing. These requirements are in accordance with the County's Substance Policy. By signing this form, you acknowledge the above and consent to such examination and screening test. Street Address Name Email Street Address Name Email Street Address Name Email Name Street Address 3 ---PAGE BREAK--- Applicant's Printed Name Applicant's Signature Date Dawson County Government is dedicated to a policy of non-discrimination. All qualified applicants will receive consideration for employment regardless of race, color, national origin, sex, religion, age, or disability. IMPORTANT INFORMATION ABOUT OUR APPLICATION PROCESS Applications are to be submitted to the Human Resources Department located in the County Administration office. Office hours are Monday-Friday between the hours of 8AM-5PM, excluding holidays. If you are applying for an open job posting, you will need to remit your application prior to or on the established closing date for that posting. The hiring department supervisor will review applications and only contact for interviews those applicants deemed most appropriate for the position within ten (10) days from the application closing date posted. If you are not contacted for an interview within that time, we will keep your application on file for six months from date of application. No other communication will be sent regarding the status of an application. I understand resumes, letters of reference, certificates, etc., submitted with the application become the property of Dawson County and cannot be returned. The information I have provided on the application is subject to public disclosure under the Georgia Open Records Act. By signing this application, I hereby acknowledge that I understand and agree to all provisions outlined herein. I certify that all the information provided by me in this application is true and complete, and I understand that misrepresentation, omissions of facts, or falsification of this information is grounds for refusal to hire, or if hired, termination. I authorize without reservation all corporations, companies, credit agencies, persons, educational institutions, law enforcement agencies, and former employers to release information they may have about me, and release them from any liability and responsibility for doing so at the request of Dawson County Government or its acting agent in the process of verifying my application for consideration of employment. I authorize you to request, receive, and verify all information given by me in this application for employment. If I am employed by the Dawson County Government, I agree to conform to the policies, rules and regulations of the government set forth in the Dawson County Government's Personnel System, employee handbook, policies, and ordinances; and acknowledge that these policies, rules, and regulations may be changed, interpreted, withdrawn, or added to by the employer at any time, at the employer's sole option. If a physical agility test and/or physical examination is required by Dawson County Government for the position I am applying, I consent to undergo the test/exam, after I have been offered employment, as deemed necessary. Employment is contingent upon successfully passing the required test/exam. I understand that this application is not a contract of employment. I further understand that if I become employed by Dawson County Government, my employment is at-will and not a contract of employment and may be terminated with or without cause at any time by me or by Dawson County. APPLICANT'S CERTIFICATION AND AGREEMENT Read carefully before signing. Unsigned applications will be disqualified. 4 ---PAGE BREAK--- Gender: Male Female Education: High School Diploma/G.E.D. Associates Degree Attended College Undergraduate Degree Professional Certification Graduate Degree Race/Ethnicity: White/Caucasian Black/African American Hispanic/Latino Asian American Indian/ Alaskan Native Native Hawaiian/ Pacific Islander Disability: Yes No Vietnam-Era Veteran: Yes No Disabled Veteran: Yes No Other Eligible Veteran: Yes No Any person who has a physical or mental impairment that substantially limits one or more major life activities; has a record of such impairment; or is regarded as having such impairment. Served in the armed forces between August 5, 1964 through May 7, 1975. A veteran with a disability (defined above), service connected or otherwise. A veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized. HUMAN RESOURCES DEPARTMENT VOLUNTARY SELF-IDENTIFICATION FORM Used for Government Monitoring Purposes Dawson County Board of Commissioners is an Equal Opportunity/Affirmative Action Employer. We are gathering the following information for recordkeeping in compliance with federal regulations. All information will be considered strictly private and confidential and will be used for EEO purposes only. Your responses are strictly voluntary and will help in developing and monitoring affirmative action programs. This form is not part of the application for employment. Failure to complete this form will not affect your application for a position. Your cooperation is appreciated. If you prefer not to reply, please leave this sheet blank. Please check all the boxes that apply to you. DAWSON COUNTY BOARD OF COMMISSIONERS 5