Human Resources Supervisor

Application for Employment

Please Print

Liberty County Commissioners

P.O. Box 829

Hinesville, Ga 31310 912-***-****

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application

or interview process should notify a representative of the Human Resources Department.

Name JOHNSON JALISA NICOLE Social Security # 249 - 77 - 6245

Last First Middle

Address 622 LIVINGSTON COURT HINESVILLE GA 31313

Street City State Zip Code

Telephone # 843-***-**** Mobile/Beeper/Other Phone # 843-***-**** E-mail Address ***************@*****.***

Position(s) applied for Date of application / /

Referral Source (Please check the appropriate category and name the source.)

Walk-in

School

Employee

Job Fair

Advertisement

Staffing Agency

Company’s Website

Government

Employment Agency

Other Internet

Other

AM

If necessary, best time to call you at home is 10 : 00 PM May we contact you at work? Yes No X

If YES, work number and best time to call: AM

Will you travel if job requires it? Yes No X

If they have been explained to you, are Yes No

you able to meet the attendance requirements of the position? : PM

Will you work overtime if required? Yes_ No X

If you are under 18 and is required, can you

furnish a work permit? Yes No_

If NO, please explain

If NO, please explain

Have you submitted an application here before? Yes No X

If YES, give date(s) and position(s)

Driver’s license number required if driving may be required

in the job for which you are applying:

State

Have you ever been bonded? Yes No X

Have you ever been employed here before? Yes No X

If YES, gives dates FROM / / TO

/ /_

Are you legally eligible for employment Yes X No

In this country?

Answering yes to the following question does not constitute an

automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position

applied for will be taken into account.

Have you ever pled guilty or no contest

to, or been convicted of a felony? Yes No X

Date available for work

/ /

If YES, please provide date(s) and details

What is your desired salary range or hourly rate of pay?

$ 22.00 Per 40 hrs per week

Type of employment desired: Full-Time X

Part-Time

Educational Co-Op

Seasonal

Temporary

Will you relocate if job requires it? Yes

No X

AN EQUAL APPORTUNITY EMPLOYER

Employment History

Starting with the most recent employer, provide the following information.

Employer Telephone#

United States Army

( _)

Month Year Month Year

Date Employed: / to /

Street Address City State

Compensation(starting)

ٱHourly ٱSalary

$ Per

Starting job title/final job title

Commission/Bonus/Other Compensation $

Immediate supervisor and title (for most recent held

position)

May we contact for

reference?

Yes No Later

Compensation (Final)

ٱ Hourly ٱ Salary

$ Per

Reason for leaving

Commission/Bonus/Other Compensation $

Summarize the type of work performed and job responsibilities.

What did you like most about your position?

What were the things you liked least about the position?

Employer Telephone#

( _)

Month Year Month Year

Date Employed: / to /

Street Address City State

Compensation(starting)

ٱHourly ٱSalary

$ Per

Starting job title/final job title

Commission/Bonus/Other Compensation $

Immediate supervisor and title (for most recent held position)

May we contact for reference?

ٱ Yes ٱ No ٱ Later

Compensation (Final)

ٱ Hourly ٱ Salary

$ Per

Reason for leaving

Commission/Bonus/Other Compensation $

Summarize the type of work performed and job responsibilities.

What did you like most about your position?

What were the things you liked least about the position?

Employer Telephone#

( _)

Month Year Month Year

Date Employed: / to /

Street Address City State

Compensation(starting)

ٱHourly ٱSalary

$ Per

Starting job title/final job title

Commission/Bonus/Other Compensation $

Immediate supervisor and title (for most recent held

position)

May we contact for

reference?

ٱ Yes ٱ No ٱ Later

Compensation (Final)

ٱ Hourly ٱ Salary

$ Per

Reason for leaving

Commission/Bonus/Other Compensation $

Summarize the type of work performed and job responsibilities.

What did you like most about your position?

What were the things you liked least about the position?

Contact this candidate