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Job Application: Communications Officer

Title: Communications Officer

Fields marked with an asterisk (*) must be filled out before submitting.

Personal Information

Last Name: *
First Name: *
Middle Name: *
Address: *
City: *
State: *
ZIP: *
Country: *
Home Phone: *
Work Phone:
Cell Phone:
E-mail: *
Drivers License Number: *
State of Driver License: *
Are You At Least 18 Years Old? * Yes
No
Are You Prevented From Becoming Lawfully Employed In This County Because Of VISA Or Immigration Status? * Yes
No

(Proof of citizenship or immigration status is required by federal law upon employment)

Did You Serve In Any Branch Of The Military? * Yes
No
If You Served In The Military, What Was Your Highest Rank?
Did You Receive An Honorable Discharge? Yes
No
Do You Drink Alcohol? * Yes
No
Have You Ever Driven A Motor Vehicle While Under The Influence Of Alcohol? * Yes
No
Have You Ever Been Convicted Of Or Plead Guilty To Driving Under The Influence? * Yes
No
Have You Ever Perjured Testimony? Yes
No
Have You Ever Committed A Crime Within The Past (5) Years That, If Known, You Believe Would Keep You From Employment With This Agency? * Yes
No
If Yes, Describe:
As An Adult (18 Years Of Age Or Older), Have You Been Convicted Of Or Plead Guilty To A Felony Crime? * Yes
No
If Yes, Describe:
Have you ever used any illegal drugs within the past (5) years? * Yes
No
Have you ever illegally sold any form of drugs in the past (5) years? * Yes
No
Have you ever illegally purchased any form of drugs in the past (5) years? * Yes
No
As an adult (18 years of age or older), have you knowingly had sexual relations with a minor? * Yes
No
Do you have any pending civil court actions where you are either the plaintiff or defendant? * Yes
No
Do you have a valid drivers license? * Yes
No
Has your drivers license been revoked or suspended? * Yes
No
Do you currently maintain at least Liability Insurance? * Yes
No
Do you object to wearing a uniform? * Yes
No
Do you object to working shift work? * Yes
No
Date you would be available to start if employed? *

Residence

Present Address From Date: *
Present Address To Date: *
Address: *
City: *
State: *
ZIP: *

Employment History

Are you employed Now? * Yes
No
If yes, may we contact your current employer? * Yes
No
If we cannot inquire of your present employer, please explain why:
Present Employment From Date: *
Present Employment To Date: *
Name of Employer: *
Address: *
City: *
State: *
ZIP: *
Title or Position: *
Phone Number: *
Beginning Salary:
Current Salary:
Your job duties are: *

Education

Complete the following information about schools you have attended.

High School Name: *
Address: *
Phone Number: *
City: *
State: *
ZIP: *
Did you Graduate? * Yes
No
 
College or University Name:
Address:
Phone Number:
City:
State:
ZIP:
Major subject area for graduate study or degree:
Did you Graduate? Yes
No
 
Note any addtional education or certifications:

References

List names and addresses of three (3) individuals, (No Relatives), who may be contacted for a professional recommendation. References must have known you for at least five (5) years.

First Reference Name: *
Occupation: *
Address: *
City: *
State: *
ZIP: *
Home Phone: *
Work Phone:
Cell Phone:
Years of Acquaintance: *
 
Second Reference Name: *
Occupation: *
Address *
City: *
State: *
ZIP: *
Home Phone: *
Work Phone:
Cell Phone:
Years of Acquaintance: *
 
Third Reference Name: *
Occupation: *
Address: *
City: *
State: *
ZIP: *
Home Phone: *
Work Phone:
Cell Phone:
Years of Acquaintance: *

Resume

Attach your Resume: Microsoft Word, Open Office, or PDF format only. *

Applicant\\\’s Certification & Agreement

(I herby understand that by checking this check-box is known to be my digital signature of this application: * Digital Signature:
 

*

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