GRAYSON COUNTY
Electronic Employment Application

An Equal Opportunity Employer M/F/D/V

INSTRUCTIONS: All questions on this application form must be answered.  If questions are not applicable enter "N/A", incomplete applications will not be processed.  Resumes will not be accepted in lieu of applications.  A false or misleading response on the application or in the interview process may result in disqualification for employment of if discovered after employment, termination of employment. 

USE YOUR TAB KEY OR MOUSE TO GO FROM FIELD TO FIELD

[I] EMPLOYMENT DESIRED

01. Describe Which Position(s) You Are Applying For:
02. When Are You Available To Start?
 03. What Is Your Desired Salary?
04. Please Indicate Type Of Employment Preferred:
Full-Time: Part-Time: Summer: Temporary:
05. Are You Legally Eligible To Work In The U.S.?
Yes: No:
06. How Were You Referred To Us:
Newspaper:    Walk-In:  Internet:  

     Other, explain:  

07. Are You Or Your Spouse Related By Blood Or Marriage To Any Employee/Official?
Yes: No:
If Yes, Please State Name And Relationship:

[II] PERSONAL INFORMATION

08. Please Enter Your Full Name:
Last Name
 First Name
 Middle Initial
09. Please Enter Address:
Street
 City
 State
 Zip Code
09a. Please Enter Optional Electronic Mail Address:
10. Social Security Number:
 11. Home Phone Number:
 12. Business Phone Number:
13. Valid Driver's License:
License Number
 Issuing State
 Type
 Expiration
14. Have You Used Any Names Or Social Security Numbers Other Than Given Above?
Yes: No:
If Yes, Please List Below:
15. Have You Ever Been Convicted Of A Felony, Within Last 7 yrs?
Yes: No:
[Conviction Will Not Necessarily Disqualify An Applicant For Employment]
If Yes, Please Explain Below:

[III] EDUCATION & TRAINING

16. High School:
Name
 Complete Address
 Field Of Study
 Graduate?
Yes: No: 		Degree Type?
Diploma: 
GED: 
17. College:
Name
 Complete Address
 Field Of Study
 Graduate?
Yes: No: 		Degree Type?
18. Graduate School:
Name
 Complete Address
 Field Of Study
 Graduate?
Yes: No: 		Degree Type?
19. Other: (Trade, Business, etc.)
Name
 Complete Address
 Field Of Study
 Graduate?
Yes: No: 		Degree?
20. Fill in requested information or the appropriate numerical rating given, as applicable/required for this position, next to each skill below (1=Extensive Experience, 2=Moderate Experience, 3=Limited Experience, 4=Training Only-no actual on-job experience):

Office Skills

Typing wpm MS Word
Shorthand wpm MS Works
10-Key MS Excel
WordPerfect Lotus 1-2-3
Multi-Line Phone Cash Handling Exp.
Other (Please List)

Road & Bridge Worker Positions Only

Front End Loader Dozer
Grade-all Dump Truck
Diesel Mechanics Backhoe
Motor Grader  
Other (Please List)
21. List Any Other Education, Training, Special Skills, Or Certificates/Licenses (CDL, etc.) That You Possess Related To This Job:
22a. Are you fluent in a language other than English? (If required for position)  Yes: No:
If Yes, which language?:    How Fluent:    Fair:  Moderate:  Excellent:  
22b. Do you write in a language other than English? (If required for position)  Yes: No:
If Yes, which language(s)?: 

[IV] EMPLOYMENT HISTORY
(List The Three Most Recent Employers Beginning With Present Employer)

23a. PRESENT OR LAST EMPLOYER
Company Name / Address
 City
 State
 Phone Number
Dates Employed
From
 To
Your Job Title
-
Name And Title Of Supervisor
-
Brief Description Of Duties
Salary (Indicate Hour, Week, Month)
HR: WK: MO: 		Reason For Leaving
23b. PREVIOUS EMPLOYER
Company Name / Address
 City
 State
 Phone Number
Dates Employed
From
 To
Your Job Title
-
Name And Title Of Supervisor
-
Brief Description Of Duties
Salary (Indicate Hour, Week, Month)
HR: WK: MO: 		Reason For Leaving
23c. PREVIOUS EMPLOYER
Company Name / Address
 City
 State
 Phone Number
Dates Employed
From
 To
Your Job Title
-
Name And Title Of Supervisor
-
Brief Description Of Duties
Salary (Indicate Hour, Week, Month)
HR: WK: MO: 		Reason For Leaving

[V] REFERENCES

Name


 Address/Phone


 Years Known/Occupation

[VI] APPLICANT'S CERTIFICATION AND RELEASE
PLEASE READ CAREFULLY BEFORE SUBMITTING

I certify that, to the best of my knowledge and belief, the answers given by me to the foregoing questions and the statements made by me are complete and true. An offer of employment is contingent on the returned criminal history, local sex offender registration and out-of-state criminal records checks that contain no disqualifying criminal history or requirement to register as a sex offender. I understand that any false information or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment.

I authorize the county and/or its agents to make inquiries to verify any of the information given in this application. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and I hereby release such persons, schools, companies and law enforcement authorities which they represent from any liability or any damages whatsoever for issuing such information. This is not an employment contract. All employment is “at will” and the relationship cannot be modified unless in writing.

[VII] SUBMISSION OF THIS FORM

Be Sure To Page Print A Copy Of This Form
For Your Records Before Submitting

 

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