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2. PERSONAL DATA
4. First Name*
5. Last Name*
7. List other names by which you have been known*
9. Address*
10. City*
12. State*
13. Zip Code*
14. Phone Number*
16. Cell Phone Number
17. Email Address*
19. Position Applied For*
    -- Select One --AppraiserApprentice Appraiser IDetention Center OfficerProject LeadPublic Works Heavy Equipment OperatorSheriff's DeputyTemporary Custodian
20. Date Available to Work*
24. EDUCATION AND TRAINING
26. Highest Grade Completed*
    -- Select One --7 or less89101112131415161718
27. Did you graduate?*

    1. Yes
    2. No
28. High School Equivalent Test (GED)*
    -- Select One --YesNoState
30. Name/Address of Last High School Attended*
31. Diploma or Degree Awarded
32. Major Field
34. Name/Address of Colleges Attended*
35. Diploma or Degree Awarded
36. Major Field
38. Name/Address of Other (Military, Trade Business, Graduate School, Etc.)*
39. Diploma or Degree Awarded
40. Major Field
42. Special Qualifications: Include Technical/Professional Licenses and Numbers; Academic and/or Professional Credentials.
46. SKILLS
48. Computer Experience (E.G. Data Entry, Word Processing, Spreadsheets)
50. Software Used (E.G. Word, Excel, Access)
52. Key Strokes Per Minute
53. Other Keyboarding Experience
55. Do you posses a valid Driver's License?*

    1. Yes
    2. No
56. Driver's License Class
    -- Select One --ABCD
60. EMPLOYMENT HISTORY

    A brief description of duties for each position is required below.  Additional details may be provided by attaching a resume, if desired. Please provide your employment history beginning with your present or most recent employer and list all positions held including military, part-time, summer, volunteer work and any periods of unemployment. 

62. Name/Address of Company*
63. Reason for Leaving*
65. Telephone Number*
66. Position Title*
67. Supervisor's Name
69. Dates of Employment*
70. Beginning/Ending Salary
72. Brief Description of Duties*
76. Name/Address of Company*
77. Reason for Leaving*
79. Telephone Number*
80. Position Title*
81. Supervisor's Name
83. Dates of Employment*
84. Beginning/Ending Salary
86. Brief Description of Duties*
90. Name/Address of Company*
91. Reason for Leaving*
93. Telephone Number*
94. Position Title*
95. Supervisor's Name
97. Dates of Employment*
98. Beginning/Ending Salary
100. Brief Description of Duties*
104. Name/Address of Company*
105. Reason for Leaving*
107. Telephone Number*
108. Position Title*
109. Supervisor's Name
111. Dates of Employment*
112. Beginning/Ending Salary
114. Brief Description of Duties*
116. May we contact the employers listed above?*

     1. Yes
     2. No
117. If not, please indicate which employer you do not wish us to contact
121. CRIMINAL, TRAFFIC, AND/OR CIVIL COURT RECORD
123. Have you ever been convicted of, pled guilty or pled nolo contendere (no contest) to a felony?*

     1. Yes
     2. No
124. If answer is yes, please give complete date/details. (A conviction will not necessarily exclude you from employment consideration).
126. In the past five (5) years, have you ever been convicted of, pled guilty, or pled nolo contendere (no contest) to a misdemeanor?*

     1. Yes
     2. No
127. If answer is yes, please give complete date/details. (A conviction will not necessarily exclude you from employment consideration.)
129. Have you ever been an employee of Barnwell County Government?*

     1. Yes
     2. No
130. Employment Dates and Position Held With Barnwell County Government
132. List three references employment related.*

     Include Name/Title, Company Name, and Phone Number

136. GENERAL INFORMATION
138. In order to prevent a delay in the processing of your application, please be sure to sign and date this form and answer every question clearly and completely.

     Each applicant considered for employment in a County position must meet the minimum requirements established for that position.  This may include the successful completion of a verbal/written examination and a drug screen.

     In compliance with the Title VI of the Consumer Protection Act, this is to advise you that as part of our processing of employment applications, an inquiry may be made concerning an applicant's credit standing, general reputation, character, and personal characteristics. This information may be from previous employers, personal references, law enforcement agencies, and/or consumer reporting agencies. Upon an applicant's written request, additional information as to the nature and scope of any report will be provided.

140. SIGNATURE AND CERTIFICATION

     I hereby affirm that the information provided on this application (and accompanying resume and/or documentation, if any) is true and complete to the best of my knowledge. I also understand that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I further understand that this application becomes the property of Barnwell County Government and will not be returned.
     
     I authorize persons, schools, my current employer (if applicable), and previous employers and organizations named in this application (and accompanying resume and/or documentation, if any) to provide any relevant information that may be required to arrive at an employment decision.

     I understand that should I be offered a position, my employment can be terminated, with or without cause, at any time at the discretion of either the County of Barnwell or myself.

142. Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
144. Electronic Signature*
145. Date*
     Date
147. We thank you for applying for employment with Barnwell County Government, an equal opportunity employer.
149. Upload your resume
150. Upload Your Completed PDF Application
Leave This Blank:


152. 1. Receive an email copy of this form.
153. Email address

     This field is not part of the form submission.

154. Submit

* indicates a required field