General Employment Application

St. Francois County Employment Application Form

St. Francois County does not discriminate against applicants on the basis of race, color, religion, gender, national origin, ancestry,
disability, age or any other characteristic protected by law St. Francois County is an Equal Opportunity Employer.

Full name

Address

Apt, suite, etc.

Country

City

State

Zip code

How Long at Address

Phone

lf under 18, please list age

Positions applied for and salary desired

How many hours can you work weekly?

Can you work nights?

Employment desired

Full-Time ONLY

Part-Time ONLY

Both

When available for work?

Education

High School

Name of School

Location (Complete mailing address)

# Of Years Completed

Major & Degree

College

Name of School

Location (Complete mailing address)

# Of Years Completed

Major & Degree

Bus. or Trade School

Name of School

Location (Complete mailing address)

# Of Years Completed

Major & Degree

Professional School

Name of School

Location (Complete mailing address)

# Of Years Completed

Major & Degree

Have you ever been convicted of a crime? *

Yes

lf yes, explain the number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

Do you have a driver's license? *

Yes

What is your means of transportation to work?

Driver's License #

State of lssue

Operator

Commercial (CDL)

Chauffeur Expiration Date

Have you had any accidents during the past three years? If yes how many ?

Have you had any moving violations during the past three years? If yes how many ?

Please list two references other than relatives or previous employers.

Name

Position

Company

Address

Telephone

Name

Position

Company

Address

Telephone

Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

Qualifications

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES?

Yes

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?

Yes

Specialty

Date Entered

Date Discharged

WORK EXPERIENCE

Please list your work experience for the past five years beginning with your most recent job held. lf you were self-employed, give firm name. Attach additional sheeb if necessary.

Name of Employer

Name of Last Supervisor

Address

Employment Dates: From

City, State, Zip Code

Pay or Salary: Start

Final

Phone Number

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of Employer

Name of Last Supervisor

Address

Employment Dates: From

City, State, Zip Code

Pay or Salary: Start

Final

Phone Number

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of Employer

Name of Last Supervisor

Address

Employment Dates: From

City, State, Zip Code

Pay or Salary: Start

Final

Phone Number

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of Employer

Name of Last Supervisor

Address

Employment Dates: From

City, State, Zip Code

Pay or Salary: Start

Final

Phone Number

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Did you complete this application yourself?

Yes

lf not, who did?

Please read the following statements carefully and indicate your understanding and acceptance by signing in the space provided.

1. l certify that all information provided by me in connection with my application, whether on this document or not, is true and complete, and I understand that any misstatement, falsification, or omission of information may be grounds for refusal to hire or, if hired, termination. 2. I understand that as a condition of employment, I will be required to provide legal proof authorization to work in the United States. 3. l authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have. personal or otherwise. with regards to any of the subjects covered by this application, and I release all such parties from all liability from any damages which may result from furnishing such information to you. 4. I understand that disclosure of my Social Security Number (SSN) is optional. The organization to which I am applying may use the SSN for administrative tracking purposes and for identification of individuals. This is in accordance with the Federal Law U S.C. 552a Section7(b). 5. I understand that if hired, a pre-employment drug screening and background check may be required. 6. I understand that Missouri law provides that employees of counties are employed "at will" and employment lasts only as long as the employer (county) desires. No reason is required to terminate the employment relationship.

Signature *

Reset Signature

Signature is required.

Date