___________________ COUNTY

EMPLOYMENT APPLICATION

AN EQUAL OPPORTUNITY EMPLOYER

The information contained on this form is sought in good faith.

It will not be used in any way to discriminate against any applicant for employment in violation of state and federal law.

IMPORTANT: Please type or print in ink. You may respond to sections 4 through 7 on separate sheets of paper if all relevant blocks are completed and the same format is followed. On each sheet write your name and job title for which you are applying. You may submit a legible photocopied application. If you photocopy your application, leave sections 1, 2, and 3 blank and complete these sections each time you apply. You must sign and date in ink each application you submit. LATE, INCOMPLETE or UNSIGNED applications will not be considered.

PLEASE READ THE JOB VACANCY ANNOUNCEMENT CAREFULLY TO FIND: (a) what attachments must be submitted (supplement questions, transcript, Employment Preference Form, etc.); (b) where to submit your application; (C) the required special qualifications or licenses; and (d) the closing date for receipt of applications. An application tailored to the position is to your advantage.

Under state and federal law, qualified applicants with disabilities are entitled to reasonable accommodations. Modifications or adjustments may be provided to assist applicants to compete in the recruitment and selection process, to perform the essential duties of the job or to enjoy equal benefits and privileges of employment available to other employees. An applicant must request an accommodation when needed.

Employment Preference: The Veterans’ Employment Preference Act and the Persons with Disabilities Employment Preference Act provide preference in public employment for certain military veterans and people with disabilities or their eligible relatives. An applicant claiming employment preference must complete an Employment Preference Form, available through your local Montana Job Service. The applicant must indicate at the bottom of page one of this application form that the necessary documentation is attached. Contact your local Montana Vocational Rehabilitation Services Office (Department of Public Health and Human Services) for details on obtaining persons with disabilities preference certification. For more information, contact your local Job Service.

1. Name________________________________________ 2. What position are you applying for?

Last First MI. (See Job Vacancy Announcement.)

Social Security No.______________________________ Department _____________

Address ______________________________________

Street Position Title ____________

_____________________________________________

City State Zip Code

Job Location_____________

Phone No._____________________________________

Work Home

3. My signature below certifies that all information on this and all attached pages (checked below) are true, correct and complete to the best of my knowledge and contain no willful falsifications or misrepresentations. Falsifications or misrepresentations may disqualify me from consideration for employment with the County or, if hired, may be grounds for termination at a later date. Employers may be contacted as references. In the spaces below, I have checked attachments, including those required in the job announcement.

ð Responses to Supplement Questions ð Transcript ð Typing/Ten-key Certification

ð Employment Preference Form/Documentation ð Resumé ð Additional Employment Experience

ð Other (specify)_____________________________________________________________________

SIGNATURE: __________________________________DATE SIGNED: _____________________

4. EDUCATION: You may respond to this section on a separate sheet of paper (on each sheet write your name and job title for which you are applying) if all relevant blocks are completed and the same format is followed.
High School Name and Address: Received Diploma or Equivalency Certificate? ”Yes ”No If “No,” enter highest grade completed__________
College, University, Other Schools & Training Courses Name and Location	Dates Attended	Degree/ Certificate Received?		Degree/ Certificate Date		Major/ Minor Field	Credits Earned- Indicate Quarter or Semester Credits
5. List current Professional Licenses, Registration, or Certifications (engineering, medical, CPA, etc.)
Licensing Agency: Name and Location			Type of License		Endorsement/Restriction If applicable			Date Licensed
6. List other skills, education, experience and abilities below. You may also include a list of equipment that you know how to use. (If you need more space, continue on an attached sheet of paper.)

7. EXPERIENCE: List your work and/or volunteer experience with emphasis on experience that is relevant to the position for which you are applying. Begin with your present or most recent experience. Include military service that would help you qualify. You may continue this section on a separate sheet of paper if all the same format is followed. Include your name and the job title for which you are applying on each sheet.

This information must be completed even if a resume is submitted.

Notice to applicants: Information that you provide on this application is subject to verification. Previous employers may be contacted as references.

Do you want to be informed before we contact your present employer? ” Yes ” No

Name & Complete Address of Employer

_____________________________________

_____________________________________

_____________________________________

Your Job Title________________________________________

Type of Business___________________________ Dates Employed________/______to_______/_________

Immediate Supervisor(s)________________________________ Phone No._______________________

Avg. Hrs. Per Week__________________ Total Time Employed _____________ Yrs/Mo ” Full-time ” Part-time ” Volunteer

Describe your duties, including knowledge, skills, abilities required, employees supervised, accomplishments

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Reason for Leaving:____________________________________________________________________________________

Name & Complete Address of Employer

_____________________________________

_____________________________________

_____________________________________

Your Job Title________________________________________

Type of Business___________________________ Dates Employed________/______to_______/_________

Immediate Supervisor(s)________________________________ Phone No._______________________

Avg. Hrs. Per Week__________________ Total Time Employed _____________ Yrs/Mo ” Full-time ” Part-time ” Volunteer

Describe your duties including knowledge, skills, abilities required, employees supervised, accomplishments

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Reason for Leaving:____________________________________________________________________________________

7. EXPERIENCE Continued...

Name & Complete Address of Employer

_____________________________________

_____________________________________

_____________________________________

Your Job Title________________________________________

Type of Business___________________________ Dates Employed________/______to_______/_________

Immediate Supervisor(s)________________________________ Phone No._______________________

Avg. Hrs. Per Week__________________ Total Time Employed _____________ Yrs/Mo ” Full-time ” Part-time ” Volunteer

Describe your duties including knowledge, skills, abilities required, employees supervised, accomplishments

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Reason for Leaving:____________________________________________________________________________________

Name & Complete Address of Employer

_____________________________________

_____________________________________

_____________________________________

Your Job Title________________________________________

Type of Business___________________________ Dates Employed________/______to_______/_________

Immediate Supervisor(s)________________________________ Phone No._______________________

Avg. Hrs. Per Week__________________ Total Time Employed _____________ Yrs/Mo ” Full-time ” Part-time ” Volunteer

Describe your duties including knowledge, skills, abilities required, employees supervised, accomplishments

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Reason for Leaving:____________________________________________________________________________________

--READ CAREFULLY--

Do Not Write On This Page

Please make sure all required information is included (see job vacancy announcement).

1. Did you sign and date your application?

2. Have you read the job announcement to see what

attachments must be submitted?

3. Have you checked boxes in Section 3 to indicate what attachments you have included?

4. Did you indicate the specific Position Title and Position Number in Section 2?

5. Did you include a complete address for each employer listed in Section 7?

6. If you are claiming Veterans Employment Preference or Persons with Disabilities Employment Preference, have you completed and attached the Employment Preference Form and Documentation?

7. Did you attach all the application materials required by the vacancy announcement?