APPLICATION FOR EMPLOYMENT

It is the policy of Carroll County to provide equal opportunity without regard to race, color, religion, sex age, national origin, marital status, disability, citizenship or veterans’ status.

 

As means of accommodation to persons with specific disabilities that prevent them from completing this application, confidential assistance in filling out this application may be obtained by calling the Human Resources Office.

APPLICANT INFORMATION

EDUCATION

Last Year Completed.
 9101112
Years
Did you Graduate? (HS)
Last Year Completed.
 1234
Years
Did you Graduate? (College)
Last Year Completed.
 1234
Years
Did you Graduate? (Graduate)
Last Year Completed.
 1234
Years
Did you Graduate? (Other)
If you did not complete high school, do you have a high school equivalency diploma?

Employment History

Starting with the most recent, describe ALL paid, military and applicable voluntary experience. Highlight your knowledge, skills and abilities which best demonstrate your qualifications for this position. You may list significantly different jobs within the same organization as separate items. You may attach additional information but cannot substitute a resume for the application. You can download the Supplementary Experience Form here and upload below to attach this to your application if you need to add more than three (3).



Employer 1
STATUS
 
 
 
Employer 2
STATUS
 
 
 
Employer 3
STATUS
May we contact your present supervisor?

LICENSES, SPECIALIZED TRAINING AND OTHER SKILLS

List any license (to include driver's), certificate or other authorization to practice a skill or trade.
 TypeLicense NumberExpiration DateGranted By (Licensing Board)
1.
2.
3.

References

Reference 1
 
 
Reference 2
 
 
Reference 3

ADDITIONAL APPLICANT INFORMATION

For purposes of compliance with The Immigration Reform and Control Act, are you legally eligible for employment in the United States? * 
Section 2.2-2804 of the Code of Virginia prohibits any board, commission, department, agency, institution or instrumentality of the Commonwealth from employing a person who is required to present himself and submit to the federal Selective Service registration requirement and failed to do so. If you are/were required to register for the Selective Service, have you done so?
For purposes of compliance with Section 2.2-2903 of the Code of Virginia, are you a veteran who received an honorable discharge and has (1) provided more that 180 consecutive days of full-time active-duty in the armed forces of the United States or reserve components thereof, including the National Guard, or (2) has a service-connected disability rating fixed by the United States Veterans Affairs? *
If YES, did you serve during the Vietnam Conflict (02/28/61 through 03/07/75)?
Have you ever been convicted* for any violation(s) of law, including moving traffic violations? * 
    If YES, please provide the following:
Check which shifts you will accept:
Check which job status you will accept:
Are you willing to accept employment which requires you to travel?
   When will you be availible to start work?

CERTIFICATION

I hereby certify that all entries on this application and attachments are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part of any employment in the service of the County of Carroll. I understand that all information on this application is subject to verification and I consent to criminal history background checks. I understand that drug screening may be required both pre-employment and during employment, and I consent to such drug screening. I also consent that you may contact references, former employers and educational institutions listed regarding this application. I further authorize Carroll County to rely upon and use, as it sees fit, any information received from such contacts. Information contained on this application may be disseminated to other agencies, nongovernmental organizations or systems on a need-to-know basis for good cause shown as determined by the agency head or designee.
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