Employment Application – The Town of Honea Path

Position(s) Applied For:

Date of Application

How Did You Learn About Us? (Please check all that apply).

Social Media

Relative

Friend

Inquiry

Other

Name

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Number

Date of Birth

Best time to contact you is

:

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Are you prevented from lawfully becoming employed in this country because of a Visa or Immigration Status?

Proof of citizenship or immigration status will be required upon employment.

What is your desired salary range?

Date available for work

Are you available to work

Fulll-Time

Part Time

Part Time (Please indicate Mornings, Afternoon or Evenings)

Mornings

Afternoon

Evenings

Temporary (Please indicate dates available)

From

To

Are you currently on “lay-off” status and subject to recall?

Can you travel if a job requires it?

Have you ever filed an application with us before?

If Yes, give date

Date

Have you ever been employed with us before?

If Yes, give date

Date

Do any of your friends or relatives, other than spouse, work here?

Are you currently employed?

May we contact your present employer?

Education

Elementary School

Name and Address of School

Course of Study

Years Completed

Diploma/Degree

High School

Name and Address of School

Course of Study

Years Completed

Diploma/Degree

Undergraduate College

Name and Address of School

Course of Study

Years Completed

Diploma/Degree

Graduate Professional

Name and Address of School

Course of Study

Years Completed

Diploma/Degree

Other

(Specify)

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Do you have any past military experience

If so, describe any job-related training received in the United States military.

EMPLOYMENT EXPERIENCE: Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer Information 1

Employer Name

Telephone Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Supervisor

Reason for leaving

Date Employed

From

To

Hourly Rate/Salary

Start

Final

Work Performed

Employer Information 2

Employer Name

Telephone Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Supervisor

Reason for leaving

Date Employed

From

To

Hourly Rate/Salary

Start

Final

Work Performed

Employer Information 3

Employer Name

Telephone Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Supervisor

Reason for leaving

Date Employed

From

To

Hourly Rate/Salary

Start

Final

Work Performed

Employer Information 4

Employer Name

Telephone Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Supervisor

Reason for leaving

Date Employed

From

To

Hourly Rate/Salary

Start

Final

Work Performed

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.

ADDITIONAL INFORMATION

Other Qualifications: Summarize special job-related skills and qualifications acquired from employment or other experience.

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone