Position or Job Title Applied For: *
Last Name *
First Name *
Middle Name
Other Name(s) under which you have been employed
Address *
City *
State *
Zip *
Social Security Number
E-mail Address
Phone Number *
Alternate Phone Number
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 an offense against the law or are you now under charges for any offense against the law? (Omit non-moving traffic violations and any offense which was finally adjudicated in a Juvenile Court or under a Youth Offender Law). *
If yes, give complete details (Date, Place, Charge, Disposition)
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.
Do you have a high school diploma or its equivalent (G.E.D./USAFI Certificate)? *
If yes, please list name and address of high school or state authority issuing the diploma or certificate
Post-Secondary education (Technical Schools/Colleges/Universities) - List appropriate information, including name, address and dates
Describe any specialized training, apprenticeship, skills, and extra-curricular activities. Include office equipment, computer skills, foreign language skills, and special honors that may relate to the position for which you are applying
Have you ever been disciplined, fired, or asked to resign from any job?
Have you ever been disciplined, fire, or asked to resign from any job?
Company Name-Current or Most Recent Employer
Telephone
Address
Employment Dates
Name of Supervisor
Salary
$
Position Held
Reason for Leaving
Company Name
Telephone
Address
Employment Dates
Name of Supervisor
Salary
$
Position Held
Reason for Leaving
Company Name
Telephone
Address
Employment Dates
Name of Supervisor
Salary
$
Position Held
Reason for Leaving
Applicant's Certification and Agreement Authorization to Release Information
Conditions of Employment
I hereby declare the information provided by me in this application is true and complete, and I understand that misrepresentation, omissions of facts, or falsification of this information are grounds for refusal to hire, or if hired, termination.
I authorize any persons or organizations to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability for any damage which may result from furnishing such information to you.
I authorize you to request, receive, and verify all information given in this application.
If I am employed by the White County Government, I agree to conform to the policies, rules, and regulations of the government set forth in the White County Government's Personnel System, employee handbook, policies, and ordinances; and acknowledge that these policies, rules and regulations may be changed, interpreted, withdrawn, or added to by the employer at any time, at the employer's sole option.
I further acknowledge that if I become employed with White County Government, my employment will be at-will and may be terminated with or without cause at any time by me or by the employer.
If required by White County Government for the position I am applying, I consent to undergo a physical examination, after I have been offered employment, as deemed necessary.
This application will remain active for sixty (60) days only unless renewed personally by me in writing.
I have read and understand the above Applicant's Certification and Agreement
I have read and understand the above Applicant's Certification and Agreement *
May We Contact Your Present Employer
Drug Free Workplace Alcohol and Controlled Substance Testing
As a condition of employment with White County Government, you will be required to submit to an alcohol and controlled substance screening test. In order to be employed by White county Government, you must successfully pass this screening test. Candidates rejected for failing to pass the required screening will be required to wait at least 12 months before reapplying for employment. Employees must, as a condition of employment, abide by the White County Substance Abuse / Drug Testing Policy. Employees who are indicted for, or convicted of, a controlled substance related violation under state or federal law, or who plead guilty or no contest to such charge must inform their Supervisor or Human Resources in writing within five days of the conviction or plead (this is a requirement of the Drug Free Workplace Act of 1988). Should you be offered a job with White County Government, your position will be subject to post accident and reasonable suspicion testing. All safety sensitive positions will be subject to random drug and alcohol testing. These requirements are in accordance with the County's Substance Policy.
I have read and understand the above Drug-Free Workplace statement. By acknowledging this you consent to such an examination and screening test.
I have read and understand the above Drug-Free Workplace statement. By acknowledging this you consent to such an examination and screening test. *
Confidential It is the policy of the White County Government to ensure equal opportunity in employment and promotion. This policy will be administered without regard to race, religion, color, national origin, martial or veteran status, sex, age, or disability.
For equal employment opportunity (EEO) statistical data, we request the following information. All information will be considered strictly private and confidential and will be used for EEO purposes only. This information is not part of the application for employment. Failure to complete this for will NOT affect your application for a position.
Your cooperation is appreciated. If you prefer not to reply, do not complete the below.
If you have questions, please contact the Human Resources Department at 706-865-2235.
Question 1 - Gender
- None - Male Female
Question 2 - Race / Ethnicity Identification
- None - Black - Not of Hispanic Origins Caucasian - Includes origins in Europe, North African, Middle East; not Hispanic or East Indian Hispanic - Including origins of Mexican, Puerto Rican, Central American, South American or other Spanish cultures. American Indian / Alaskan Native Asian / Pacific Islander Other
Additional Forms Additional forms such as background consent form and motor vehicle record will be required should you be called in for an interview. We will also request a copy of your drivers license.
We are an Equal Opportunity Employer Thank you for your interest in White County. Please click on submit.
