Supervisor Graduate
Resume:
STATE OF MISSISSIPPI APPLICATION
Return Completed Application to:
Mississippi Department of Transportation
P.O. Box 1850
Jackson, MS 39215
www.mdot.ms.gov
For Staff/Official Use Only
Received:
Important! Please Read Before you begin the application process: Please submit one application per job posting. Please be sure to complete the entire application. Applications lacking sufficient information will be processed and returned as invalid. Please ensure your application is received or postmarked by the closing date as indicated on the job posting.
-TYPE OR PRINT IN BLACK INK-
JOB INFORMATION
JOB NUMBER: POSITION TITLE:
PERSONAL INFORMATION
FIRST NAME MIDDLE INITIAL LAST NAME
ADDRESS
CITY STATE ZIP
HOME PHONE ALTERNATE PHONE
MONTH AND DATE OF BIRTH WHICH METHOD DO YOU PREFER TO BE NOTIFIED ABOUT YOUR APPLICATION STATUS? EMAIL OR PAPER
EMAIL ADDRESS
EDUCATION
WHAT IS YOUR HIGHEST LEVEL OF EDUCATION:
Some High School Some College Associate’s Degree Master’s Degree Doctorate Degree High School Technical College Bachelor’s Degree Specialist’s Degree HIGH SCHOOL EDUCATION
DID YOU GRADUATE FROM HIGH SCHOOL/RECEIVE A G.E.D.? YES NO IF NO, WHAT WAS THE HIGHEST GRADE LEVEL COMPLETED? 7 8 9 10 11 12 COLLEGE/UNIVERSITY EDUCATION
SCHOOL NAME DEGREE RECEIVED
DATES ATTENDED
DID YOU GRADUATE?
YES NO
SEMESTER QUARTER
# OF UNITS COMPLETED:
SCHOOL LOCATION (CITY/STATE) MAJOR
SCHOOL NAME DEGREE RECEIVED
DATES ATTENDED
DID YOU GRADUATE?
YES NO
SEMESTER QUARTER
# OF UNITS COMPLETED:
SCHOOL LOCATION (CITY/STATE) MAJOR
SCHOOL NAME DEGREE RECEIVED
DATES ATTENDED
DID YOU GRADUATE?
YES NO
SEMESTER QUARTER
# OF UNITS COMPLETED:
SCHOOL LOCATION (CITY/STATE) MAJOR
2
Rev 5/2011
CERTIFICATES & LICENSES
TYPE
DATE ISSUED (MONTH/YEAR)
EXPIRATION DATE (MONTH/YEAR)
LICENSE NUMBER
ISSUING AGENCY
SPECIALIZATION
TYPE
DATE ISSUED (MONTH/YEAR)
EXPIRATION DATE (MONTH/YEAR)
LICENSE NUMBER
ISSUING AGENCY
SPECIALIZATION
TYPE
DATE ISSUED (MONTH/YEAR)
EXPIRATION DATE (MONTH/YEAR)
LICENSE NUMBER
ISSUING AGENCY
SPECIALIZATION
WORK HISTORY
DATES
From
To
EMPLOYER
POSITION TITLE
ADDRESS, CITY, STATE
PHONE NUMBER
SUPERVISOR (NAME & TITLE)
HOURS PER WEEK
SALARY
MAY WE CONTACT THIS EMPLOYER?
YES NO
DUTIES
DATES
From
To
EMPLOYER
POSITION TITLE
ADDRESS, CITY, STATE
PHONE NUMBER
SUPERVISOR (NAME & TITLE)
HOURS PER WEEK
SALARY
MAY WE CONTACT THIS EMPLOYER?
YES NO
DUTIES
3
Rev 5/2011
WORK HISTORY
DATES
From
To
EMPLOYER
POSITION TITLE
ADDRESS, CITY, STATE
PHONE NUMBER
SUPERVISOR (NAME & TITLE)
HOURS PER WEEK
SALARY
MAY WE CONTACT THIS EMPLOYER?
YES NO
DUTIES
DATES
From
To
EMPLOYER
POSITION TITLE
ADDRESS, CITY, STATE
PHONE NUMBER
SUPERVISOR (NAME & TITLE)
HOURS PER WEEK
SALARY
MAY WE CONTACT THIS EMPLOYER?
YES NO
DUTIES
4
Rev 5/2011
AGENCY WIDE QUESTIONS
1. ARE YOU CURRENTLY EMPLOYED WITH THE STATE OF MS? YES NO 2. IF YOU ANSWERED “YES” TO THE PREVIOUS QUESTION, INDICATE WHICH AGENCY AND YOUR CURRENT JOB TITLE. (IF YOU PREVIOUSLY INDICATED
“NO”, PROCEED TO THE NEXT QUESTION.)
(AGENCY NAME) (CURRENT JOB TITLE)
3. HAVE YOU BEEN SEPRATED WITHIN THE LAST 12 MONTHS FROM THE STATE OF MS DUE TO A REDUCTION IN FORCE (RIF)? YES NO 4. IF YOU ANSWERED “YES” TO THE PREVIOUS QUESTION, INDICATE WHICH AGENCY, YOUR PREVIOUS JOB TITLE, AND THE DATE OF YOUR RIF SEPARATION. (IF YOU PREVIOUSLY INDICATED “NO”, PROCEED TO THE NEXT QUESTION.)
(AGENCY NAME) (PREVIOUS JOB TITLE) (DATE OF RIF)
5. ARE YOU A VETERAN OF THE ARMED FORCES? YES NO
(IF YOU INDICATED “YES”, YOU MUST ATTACH A COPY OF YOUR DD214 OR OTHER PROOF OF SERVICES.) 6. IF YOU ARE A VETERAN, WERE YOU DECLARED DISABLED? YES NO 7. ARE YOU AN ADULT MALE BORN ON OR AFTER JANUARY 1, 1960 WHO REGISTERED FOR SELECTIVE SERVICE BETWEEN THE AGES OF 18 AND 25? YES NO
TO MEET THE REQUIREMENTS OF FEDERAL REGULATIONS, MSPB NEEDS TO COLLECT INFORMATION ON THE QUESTIONS BELOW FOR REPORTING PURPOSES ONLY. THIS INFORMATION WILL NOT BE USED FOR MAKING EMPLOYMENT DECISIONS. (OPTIONAL) 8. INDICATE YOUR RACE
AMERICAN INDIAN
WHITE
HISPANIC
BLACK
ASIAN
Other
9. INDICATE YOUR GENDER
MALE
FEMALE
10. AGE GROUP:
UNDER 18
18-25
26-39
40-54
55-69
70+
ADDITIONAL INFORMATION
Additional Information (other schools or training; special qualifications; honors and awards; etc.): APPLICANT DECLARATIONS
By signing this application, I certify that all statements made herein and on any attached documents are true and complete to the best of my knowledge. I authorize the verification of this information by the Mississippi State Personnel Board and any agency considering me for employment. I know that any misrepresentation herein may lead to rejection of my application, removal of my name from the list of eligibles, and/or dismissal from state service. I understand that, as a condition of employment, I will be required to present documentation which verifies both my identity and my employment eligibility pursuant to federal immigration law.
X SIGNATURE OF APPLICANT DATE
5
Rev 5/2011
Supplemental Page
Last Name First Name
JOB INFORMATION
JOB NUMBER:
POSITION TITLE:
COLLEGE/UNIVERSITY EDUCATION
SCHOOL NAME
DEGREE RECEIVED
DATES ATTENDED
DID YOU GRADUATE?
YES NO
SEMESTER QUARTER
# OF UNITS COMPLETED:
SCHOOL LOCATION (CITY/STATE)
MAJOR
SCHOOL NAME
DEGREE RECEIVED
DATES ATTENDED
DID YOU GRADUATE?
YES NO
DATES ATTENDED
SCHOOL LOCATION (CITY/STATE)
MAJOR
CERTIFICATES & LICENSES
TYPE
DATE ISSUED (MONTH/YEAR)
EXPIRATION DATE (MONTH/YEAR)
LICENSE NUMBER
ISSUING AGENCY
SPECIALIZATION
TYPE
DATE ISSUED (MONTH/YEAR)
EXPIRATION DATE (MONTH/YEAR)
LICENSE NUMBER
ISSUING AGENCY
SPECIALIZATION
WORK HISTORY
DATES
From
To
EMPLOYER
POSITION TITLE
ADDRESS
CITY
STATE
COMPANY WEBSITE
PHONE NUMBER
SUPERVISOR (NAME & TITLE)
HOURS WORKED PER WEEK
MONTHLY SALARY
MAY WE CONTACT THIS EMPLOYER?
YES NO
DUTIES
Contact this candidate