Columbus Day News

APPLICATION FOR EMPLOYMENT (Pre-employment questionnaire) (An Equal Opportunity Employer) INSTRUCTIONS: Please answer all questions completely and accurately. No action can be taken on this application until all questions have been answered. Type or print clearly. Use ink. Please provide a resume if desired, but not in place of completing this application. WE ARE AN EQUAL OPPORTUNITY EMPLOYER Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job related medical condition or disability. Date: Name: Last First Middle Initial Present Address: Street City State Zip Permanent Address: Street City State Zip Phone No.: Alternate Phone No.: Email Address: Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? ☐ Yes ☐ No Proof of Citizenship or Immigration Status will be required upon employment. Have you ever filed an application with this company before? ☐ Yes ☐ No If yes, give date and position applied for: Are you currently employed? ☐ Yes ☐ No If yes, may we contact your present employer? ☐ Yes ☐ No Are you available to work: ☐ Full Time ☐ Part Time ☐ Shift Work ☐ Temporary Days/Hours available to work: Salary or wage desired: per Do you have a valid Driver’s License? ☐ Yes ☐ No State: Number: Have you ever been convicted of a crime? ☐ Yes ☐ No Note: A conviction record will not necessarily be a bar to employment. If yes, explain: EMPLOYMENT EXPERIENCE (List below last four (4) employers, starting with the most recent one first.) Dates Employed Name of Employer Job Title Reason for Leaving Mo/Yr To Mo/Yr Address Phone No. Dates Employed Name of Employer Job Title Reason for Leaving Mo/Yr To Mo/Yr Address Phone No. Dates Employed Name of Employer Job Title Reason for Leaving Mo/Yr To Mo/Yr Address Phone No. Dates Employed Name of Employer Job Title Reason for Leaving Mo/Yr To Mo/Yr Address Phone No. SKILLS AND QUALIFICATIONS Summarize special job-related skills and qualifications acquired from employment or other experience. EDUCATION School Name Location Course of Study Did you Graduate? Diploma/Degree High School ☐ Yes ☐ No College ☐ Yes ☐ No Other ☐ Yes ☐ No REFERENCES List three references who are not related to you and are not previous employers. Name Address Phone Number Years Known 1. 2. 3. IN CASE OF EMERGENCY, NOTIFY Name: Relationship: Phone Number: Address: APPLICANT – PLEASE READ AND SIGN I certify that all information I have provided in this Application for Employment is true, correct and complete. I understand that any false, misleading or omitted information could disqualify me from further consideration for employment and could result in dismissal if discovered at a later date. I authorize the Suwannee County Tax Collector’s Office to investigate all statements contained in this application as may be necessary for the employment decision. I authorize my previous employers, educational institutions and references to disclose any information regarding my previous employment, education and/or qualifications for employment. I understand that I have the right to review personnel records maintained by the Suwannee County Tax Collector’s Office about me, subject to certain limitations as provided by law. I understand that this application is not a contract, offer or promise of employment and that if hired, I will be able to resign at any time for any reason. Similarly, if hired, the Suwannee County Tax Collector’s Office will be able to terminate my employment at any time, with or without cause. I understand that the Suwannee County Tax Collector’s Office participates in E-Verify and will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee’s Form I-9 to confirm work authorization. I understand that the Suwannee County Tax Collector’s Office is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job related medical condition or disability. Signature of Applicant Date