Employment Application

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address City State ZIP Code

Type of work you would accept(Required)

Full Time

Part Time

Summer

Temporary

What date would you be available for work?(Required)

Have you ever filed an application with Appanoose County before?(Required)

Yes

If yes, Month/Year

Have you ever been employed with Appanoose County before?(Required)

Yes

If yes, in what capacity?

What dates were you employed by Appanoose County?

What was your reason for leaving?

What is the minimum salary that you would accept?(Required)

Would you be willing to work overtime if required?(Required)

Yes

Would you be willing to relocate if required?(Required)

Yes

Would you be willing to travel if required?(Required)

Yes

Do you have any relatives, including in-laws, currently employed by Appanoose County?(Required)

Yes

If yes, what is their name, relationship to you, and department in which they are employed.(Required)

Are you legally eligible to be employed in the U.S.?(Required)

Yes

Proof of identity and eligibility will be required upon employment

Are you 18 years old or older?(Required)

Yes

Proof of identity and eligibility will be required upon employment

If you are under 18 years of age, can you provide required proof of your eligibility to work?(Required)

Yes

Have you ever been convicted of a crime (other than a minor traffic violation)?(Required)

Yes

If yes, please indicate the nature of the offense, date, state and disposition.(Required)

Do you have a record of founded child or dependent adult abuse?(Required)

Yes

Such a record will not necessarily disqualify an applicant. The circumstances of the conviction will be considered in relation to the nature and duties of the postition.

Veterans Preference

Chapter 35C, Code of Iowa, provides certain rights, including preference in hiring if equally qualified to other applicants, to certain veterans of United States Military Service. Qualifications for these rights is defined in this statute.

Are you a Veteran of United States Military Services?(Required)

Yes

Please list Branch of Service and Dates of Active Duty(Required)

Are you a member of the Reserves or National Guard?(Required)

Yes

Any person who may wish to claim a Veterans Preference must submit a copy of a certified form DD214 by the deadline set for the receipt of applications for the position that the person is applying for.

Education

High School

High School Name(Required)

High School Location(Required)

Diploma/GED(Required)

Undergraduate

College/University Name

College/University Location

Diploma/Degree

Course of Study

Graduate/Professional

College/University Name

College/University Location

Diploma/Degree

Course of Study

Additional Training/Education

Any additional education, please list details:

Describe any skills, specialized training, apprenticeship, certifications, licensures, and applicable extra-curricular activities.

List equipment and computer software you can operate if appicable to the position. (Include type, tasks performed, and years of experience.)

List construction equipment previously operated if applicable to the position. (Include type, tasks performed and years of experience)

Employment Experience

List previous employment. Start with your present or last job.

Job

Employer

Job Title

Supervisor

Address

Street Address City State ZIP Code

Phone

Dates Employed From/To

Hourly Rates/Salary - Starting/Final

Work Performed

Reason for leaving

May we contact the employer listed above?

Yes

If no, why?

Job

Employer

Job Title

Supervisor

Address

Street Address City State ZIP Code

Phone

Dates Employed From/To

Hourly Rates/Salary - Starting/Final

Work Performed

Reason for leaving

May we contact the employer listed above?

Yes

If no, why?

Do you have additional jobs to list?

Yes

Job

Employer

Job Title

Supervisor

Address

Street Address City State ZIP Code

Phone

Dates Employed From/To

Hourly Rates/Salary - Starting/Final

Work Performed

Reason for leaving

May we contact the employer listed above?

Yes

If no, why?

Job

Employer

Job Title

Supervisor

Address

Street Address City State ZIP Code

Phone

Dates Employed From/To

Hourly Rates/Salary - Starting/Final

Work Performed

Reason for leaving

May we contact the employer listed above?

Yes

If no, why?

Do you have additional jobs to list?

Yes

Job

Employer

Job Title

Supervisor

Address

Street Address City State ZIP Code

Phone

Dates Employed From/To

Hourly Rates/Salary - Starting/Final

Work Performed

Reason for leaving

May we contact the employer listed above?

Yes

If no, why?

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. If I wish to be considered for employment beyond this time period, I understand that I need to inquire as to whether or not applications are being accepted at that time.

I hereby acknowledge that any employment relationships with Appanoose County is of an at-will nature, which means that the employee may resign at any time and that Appanoose County may discharge at any time with or without cause. I understand that neither this document nor any offer of employment from Appanoose County constitutes an employment contract unless a specific document to that effect is executed by Appanoose County and be in writing.

I hereby acknowledge that as a condition of employment I may be required to submit to, and successfully pass, a criminal background check, credit history check, post-offer pre-employment physical and drug screen.

In the event of employment, I understand that false or misleading information given in my application or interview(s) shall be considered sufficient cause for dismissal. I further understand that an incomplete application or an absence of my signature on this application is just cause for rejection of this application. I agree to employment entrance exams, if necessary, at Appanoose County cost. I understand that I am required to abide by all rules and regulations of the employer.

Signature(Required)

If you have a resume you would like to add, please attach here.

Drop files here or

Max. file size: 128 MB.

Appanoose County provides equal employment opportunities to all applicants for employment and to all employees and does not discriminate on the basis of age, race, creed, color, sex (including pregnancy), sexual orientation, gender identity, national origin, religion, disability, genetic information or any other legally protected status or characteristic.

Please be advised that because Appanoose County is a public entity, it is subject to the requirements of Chapter 22, Code of Iowa, regarding the examination of public records, and this application may be subject to examination under this statute.