Last Name *
First Name *
Middle Name
Other Name(s) under which you have been employed, including maiden name or any alias used
Address *
Mailing address if different than physical
City *
State *
Zip *
E-mail Address *
Cellphone Number *
Cellphone Carrier *
Alternate Phone Number
Preferred method to be contacted: Phone Call, Text and/or Email (texting would only be used for initial contact - msg & data rates may apply) *
Availability
Minimum Salary Requirement
$
Are you 18 years old or older
- None - Yes No
Eligible to work in the United States? *
- Select - Yes No
Note: If offered employment you will be required to provide documentation to verify employment eligibility. Failure to provide the requested documentation may result in a determination that the applicant is ineligible for employment in the United States.
Have you worked for us before?
If yes, when and what department?
Give name, relationship, & department of any relatives currently employed with White County Government
Are you able to preform the job duties listed for the position you are applying for without an accommodation? *
If no, what accommodation is needed?
If required by this position, do you have a valid driver's license? *
Licenses #
State
Type
Have you had any traffic violations in the past 3 years? *
If yes, type of offense and dates
Have you ever been convicted of, or plead guilty or NOLO to a felony or misdemeanor, other than a minor traffic violation? *
If yes, please attach a written statement that answers what, where, when, the specific circumstances surrounding the event, as well as the outcome.
Note: A conviction will not necessarily bar you from employment. Each conviction will be judged on it's own merits with respect to time, circumstances and seriousness.
