Employment Application

Richland County is an equal opportunity employer. Richland County does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law.

Application for Employment

Step 1 of 3

33%

Personal Information

Incomplete information could disqualify you from further consideration. Please complete all fields.

Name(Required)

First Last

Email Address(Required)

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Mobile Phone

Are you eligible to work in the U.S?

Yes

Are you at least 18 years or older?

(If no, you may be required to provide authorization to work.)

Yes

Have you ever been terminated from employment or asked to resign by an employer?

Yes

If yes, please provide company names and details:

Can you work any shift?

Yes

If no, explain:

What hours are you able to work?

NOC

Which days of the week are you able to work?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Can you work overtime, including weekends?

Yes

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

Yes

Employment Desired

Date you can start

Month

Day

Year

Hourly rate / Salary desired

Position desired

Are you currently employed?

Yes

If so may we inquire of your present employer?

Yes

Referral Source

How did you hear about us?

Walk In

Referral

Other

Have you ever worked for this company before?

Yes

Explain:

Do you know anyone who works for our company?

Yes

If yes, who?

Education

List High School, College, University, Trade, Business or Correspondence School under Education.

Education

Name and Location of School

Degree Received

Subjects Studied/Major

Employment History

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Previous Employment

Please list your previous employers, the dates you worked and the position you held

Start Date

End Date

Employer

Job Title

Phone

Reason for Leaving

Tell Us About Yourself

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain.

References

Professional References

Give the names of three persons not related to you, whom you have known at least three (3) years.

Name

Address

Phone

Company

Years Acquainted

Attachements

Please attach your cover letter and résumé.

Drop files here or

Accepted file types: pdf, doc, Max. file size: 2 MB, Max. files: 4.

Please read carefully before signing.(Required)

PRE-EMPLOYMENT STATEMENT: Any misrepresentation or omission of any fact in my application, resume, or any other materials, or during any interviews, can be justification for refusal of employment, or if employed, termination from Richland County employ. Any offer of employment I may receive is contingent upon my successful completion of the total pre-employment screening process, including Richland County receiving references that it considers satisfactory, and my satisfactory completion of any post offer medical examination that the agency may require. I understand that as a condition of employment, I will be required to undergo and successfully pass a screening for alcohol/drugs. I also understand and agree that, if employed, I will be required to submit to an alcohol/drug screening at any time at the discretion of Richland County. In processing my application for employment, Richland County may verify all the information provided by me, including my prior employment, military records, education, criminal and driving record. I authorize and request that all of my present/former employers and those individuals I have listed as references furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability for damages arising from furnishing the requested information. In consideration of my employment, I agree to comply with the policies, rules, regulations and procedures of Richland County and understand that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of the either the agency or myself. I consent to and authorize the use and reproduction by Richland County of any and all photographs and any other audiovisual materials taken of me for promotional printed material, educational activities and exhibitions or for any other use for the benefit of the agency.

I hereby authorize the Human Resource Department of Richland County and Pine Valley Community Village to investigate without liability the information supplied by me in my application for employment including academic, occupational, health, police, and government records.

Also, I authorize listed past employers and personal references to make full response without liability to any inquiries by the Human Resource Department of Richland County and Pine Valley Community Village in connection with this application for employment. *Typed name will be considered as signature if submitting electronically*

I understand and voluntarily agree that the information I have provided on this application is true and complete to the best of my knowledge.

Signature(Required)

Name

This field is for validation purposes and should be left unchanged.