Application

Marshall County Employment Application

Required fields are marked with an asterisk (*).

1. Position Applied For * Choose an open position. Mechanic
2. Date of Application
3. How Did You Learn About Us?

   Advertisement

   Friend

   Walk-In

   Employment Agency

   Relative

   Other
4. If Other, explain
5. Last Name *
6. First Name *
7. Middle Name
8. Address *
9. City *
10. State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
11. Zip Code *
12. Telephone Number(s) *

Employment Questions

1. Have you ever filed an application with Marshall County before?

   Yes

   No
2. If yes, give date
3. Have you ever been employed with Marshall County before?

   Yes

   No
4. If yes, give date
5. Are you currently employed?

   Yes

   No
6. Have you served in the United States Military?

   Yes

   No
7. Dates of Active Duty: From
8. To
9. Type of Discharge
10. Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?

    Yes

    No
11. On what date would you be available for work?
12. Are you available for work?

    Full Time

    Part Time

    Shift Work

    Temporary
13. Are you currently on lay-off status and subject to recall?

    Yes

    No
14. Have you been convicted of a felony within the last 7 years?

    Yes

    No
15. If yes, please explain

Employment Experience

Employment 1

Employer

Telephone

Address

City

State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Date Employed From

Date Employed To

Job Title

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Immediate Supervisor and Title

Reason for Leaving

May we contact for reference?

Yes

No

Later

Summarize the nature of the work performed and job responsibilities

Add Employer

Employment 2

Employer

Telephone

Address

City

State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Date Employed From

Date Employed To

Job Title

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Immediate Supervisor and Title

Reason for Leaving

May we contact for reference?

Yes

No

Later

Summarize the nature of the work performed and job responsibilities

Add Employer

Employment 3

Employer

Telephone

Address

City

State Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Date Employed From

Date Employed To

Job Title

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Immediate Supervisor and Title

Reason for Leaving

May we contact for reference?

Yes

No

Later

Summarize the nature of the work performed and job responsibilities
1. Comments, including explanation of any gaps in employment
2. Skills and Qualifications

Education

1. High School
2. Location
3. From
4. To
5. Did you graduate high school?

   Yes

   No
6. Diploma/Degree
7. College
8. Location
9. From
10. To
11. Did you graduate college?

    Yes

    No
12. Degree
13. Other
14. Location
15. From
16. To
17. Did you graduate other school?

    Yes

    No
18. Degree
19. Specialized training, apprenticeship, skills and extra-curricular activities
20. Honors received
21. Additional information helpful to considering your application
22. Professional, trade, business or civic activities and offices held

References

1. Personal References

2. Personal Reference 1 Name, Title, and Phone
3. Personal Reference 2 Name, Title, and Phone
4. Personal Reference 3 Name, Title, and Phone

5. Professional References

6. Professional Reference 1 Name, Title, and Phone
7. Professional Reference 2 Name, Title, and Phone
8. Professional Reference 3 Name, Title, and Phone

Applicant Statement

1. Are you capable of performing, with or without a reasonable accommodation, the essential functions of the job for which you have applied?

   Yes

   No

All applicants for employment may be required to submit to a drug and alcohol test after a conditional offer of employment has been made. The results of the drug and alcohol tests will be provided to the County. If you are currently using illegal drugs or controlled substances, you are not eligible for employment. If you use illegal drugs or controlled substances after you have been employed, you will be subject to disciplinary action or dismissal. This policy does not apply to the use of medications which have been prescribed for an individual by a licensed medical practitioner and which are used strictly in accordance with the prescription.

Applicant Acknowledgment

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. In connection with my application for employment with the County, I expressly authorize the release to the County of any records or information which may refer or relate to my application for employment, including, but not limited to, records of schools, law enforcement or criminal justice agencies, social media accounts and previous employers. I hereby release and discharge the County and any other person, firm, agency or corporation from any and all claims and liability which I may have or ever claim to have relating to information provided to the County as part of my application for employment.

This application for employment shall be considered active for a period of time not to exceed one year. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

The applicant understands that neither this document nor any offer of employment from the employer constitutes an employment contract, unless the employer and employee in writing execute a specific document to that affect.

In the event of employment, I understand that false or misleading information given in this application or my interview(s) may result in discharge, that I am required to abide by all rules and regulations of the employer, and I may be required to satisfactorily pass a physical examination given by a physician designated by the county and asked to sign a consent for release of medical information derived from said examination.

I certify that I am 18 years old or older.

Criminal Background History

In connection with your employment application or your actual employment, Marshall County may obtain a criminal background report about you for employment purposes. The information contained in such criminal background reports may be used by Marshall County for employment purposes, such as hiring you. If you are hired by the company, the information in a criminal background report and/or investigative criminal background report may be used for other employment purposes, such as promotion, retention and termination.

A criminal background report may contain the following types of information about you: criminal history including felony filings, misdemeanor filings, and motor vehicle records, general reputation, personal characteristics, or mode of living that is compiled through the use of personal interviews with references, employers, neighbors, friends, associates, etc. You have a right to request disclosure of the nature and scope of the reports.

I authorize Marshall County to obtain criminal background reports and/or investigative criminal background reports for the pre-employment background investigation, and, if I am hired, at any time during my employment. I understand that these reports might include, but are not limited to, a search of my criminal background, reference checks, driving record checks, and verification of my identification and Social Security Number. I agree that this disclosure/authorization, in original or copy form, is valid for all current and future criminal background reports.

By signing below, I understand that Marshall County may use such criminal background reports for employment purposes, including, but not limited to, hiring, promotion, retention, and termination.

2. Signature of Applicant *
3. Date

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