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APPLICATION FOR EMPLOYMENT GREENE COUNTY BOARD OF COMMISSIONERS 1034 Silver Drive Suite 201 Greensboro, GA 30642 FAX # [PHONE REDACTED] PHONE # 706- 453-7716 GENERAL INFORMATION Evaluations of applications are based on individual merit. Information MUST BE COMPLETE so that all applications can be given equitable consideration. All qualified applicants will receive consideration for employment regardless of race, color, religion, sex, age, national origin or disability. Greene County will hire only authorized workers, regardless of national origin. This application must be typed or printed. Please complete one application for each position for which you apply. YOU MUST SIGN AND DATE YOUR APPLICATION IN INK. INCOMPLETE APPLICATIONS MAY BE REJECTED. RESUMES ARE NOT ACCEPTED IN LIEU OF A COMPLETED APPLICATION. PERSONAL DATA Job Announcement Closing Position Desired Salary Requirement Name first middle initial last Address street apt. # city state zip code Telephone home work other How did you hear of this opening? Date available to begin work? Have you ever worked for Greene County Gov't.? Yes No When & Where? Give name, relationship and department of any relatives who are employed with Greene County Gov't. Will you accept: Temporary work? Yes No Part-time work? Yes No Shiftwork? Yes No Week-end/Holiday? Yes No Are you over 18 years old? Yes No Are you a citizen of the U.S.? Yes No Are you legally eligible 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. Email Address ---PAGE BREAK--- Do you have a valid Drivers License? Yes No License # State Do you have a valid Commercial Drivers License? Yes No What Classification? NOTE: Possession of a valid drivers license is not an essential function of all employment offered by the County. Answering "No" to this question is not necessarily a bar to consideration for employment. If offered employment, applicants will be required to obtain a current copy of their Motor Vehicle Records Report from the appropriate designated agency and provide it to Greene County. Have you received any traffic citations in the past 3 years? Yes No Please indicate type of offense and dates Have you (since the age of 18) ever been convicted of or plead guilty or no contest to a misdemeanor? Yes No Have you (since the age of 18) ever been convicted of or plead guilty or no contest to a felony? Yes No If YES, describe circumstances NOTE: Any applicant convicted of any criminal offense involving the manufacture, distribution, trafficking, or sale of a controlled substance, dangerous drugs or marijuana, or convicted of any felony involving a violent crimes such as assault with a deadly weapon, aggravated assault or murder are ineligible for employment with Greene County. Such applicants shall be automatically rejected. Applicants convicted of any other felony will be considered on a case-by-case basis. Any applicant who has been convicted of any felony or misdemeanor and has received a pardon from the appropriate State Pardons/Parole Board shall be eligible for employment with the County. By signing this application, applicants agree to submit to a background investigation by Greene County and will also be required to submit to pre-employment drug testing as designated and provided for by the County. Have you ever been suspended, dismissed or asked to resign from any job? Yes No If YES, explain in detail EDUCATION HIGH SCHOOL Name: Location: Circle the highest grade completed: 7 8 9 10 11 12 Graduated? Yes No If not a high school graduate, do you have a GED? Yes No COLLEGES/UNIVERSITIES NAME OF SCHOOL CITY STATE HRS. EARNED QTRS. EARNED MAJOR DEGREE EARNED Describe special vocational or business courses you have taken which relate to the job for which you are applying. Special skills, qualifications, and certifications (including language skills, typing skills, and business equipment or machine operating skills) which relate to the job for which you are applying. ---PAGE BREAK--- WORK HISTORY Describe your work history BEGINNING WITH YOUR CURRENT OR MOST RECENT JOB. Include military, volunteer experience and periods of unemployment. Failure to give complete information regarding each job held will result in your disqualification. Complete address with zip code and phone numbers for all employers are necessary. A resume may be attached only as additional information and will not be accepted in lieu of completing this section. Name of Organization or Firm Telephone ( ) - Dates Employed From Mo/Yr To Mo/Yr Address Street City State Zip Code Total Time Employed: Official Job Title Name of Supervisor Pay Start End Describe Specific Job Duties Specific Reason for Leaving Name of Organization or Firm Telephone ( ) - Dates Employed From Mo/Yr To Mo/Yr Address Street City State Zip Code Total Time Employed: Official Job Title Name of Supervisor Pay Start End Describe Specific Job Duties Specific Reason for Leaving Name of Organization or Firm Telephone ( ) - Dates Employed From Mo/Yr To Mo/Yr Address Street City State Zip Code Total Time Employed: Official Job Title Name of Supervisor Pay Start End Describe Specific Job Duties Specific Reason for Leaving ---PAGE BREAK--- Name of Organization or Firm Telephone ( ) - Dates Employed From Mo/Yr To Mo/Yr Address Street City State Zip Code Total Time Employed: Official Job Title Name of Supervisor Pay Start End Describe Specific Job Duties Specific Reason for Leaving Please use this space for additional information pertinent to your education, training and experience: AUTHORIZATION TO RELEASE INFORMATION I have made application for employment with Greene County Government. I authorize my former employers to give any information regarding my employment and/or any information they have regarding me, whether or not it is in their records. I hereby release them from any damage whatsoever for issuing same. May we contact your present employer? Yes No You must sign the "Authorization to Release Information" statement to enable us to contact prior employers, even though we may not contact your present employer. Date Applicant's APPLICANTS CERTIFICATION AND AGREEMENT I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I am aware that the falsification of this application or the omission of complete information will result in disqualification, or upon discovery, termination of employment. The County is hereby authorized to make any investigation of my prior educational and work history. Date Applicant's Resumes, letters of reference, etc. submitted with the application become property of Greene County and cannot be returned. The information you have provided on the application is subject to public disclosure under the Georgia Open Records Act.