Career Opportunities Application Form "*" indicates required fields Step 1 of 6 16% Personal InformationName* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Work PhoneCall in Confidence? Yes Email* Are You Authorized to Work in the United States?* Yes No Are You 18 Years of Age or Older?* Yes No Have You Served in the U.S. Armed Forces?* Yes No Branch Rank If the Job You Are Applying For Requires Driving a Vehicle, Do You Have a Valid Driver's License? Yes No Do You Have A Chauffeur's License? Yes No Do You Have A Commercial Driver's License? Yes No License Type Endorsements Is Your License Currently, or has it ever been revoked, suspended or restricted?* Yes No Please Explain:*Have You Ever Been Convicted of a Felony or Misdemeanor?* Yes No Please State When, Where and the Nature of the Offense:* Employment DesiredThis application will only be considered for the open position listed and will expire when the open position is filled. Position Applying For:* Department* Applying for:* Full Time Part-Time Temporary On-Call Seasonal Are You Available to Work Weekends When Required by the Position You Have Applied For?* Yes No Specify Days and Hours that You Would NOT Be Available to Work:Are You Currently Employed?* Yes No Date You Are Available to Start Work:* MM slash DD slash YYYY List Any Relatives that are Currently Employed by the County of Barry: Employment HistoryAdd Employment History Employment Name Employment Address Employment Phone Position Held: Employment Type Pay Rate Job Responsibilities Reason For Leaving Explanation: Employment Date (From) Employment Date (To) Supervisor's Name & Title Actions Edit Delete There are no Employers. Add Employer Maximum number of employers reached. EducationAdd Education School Name School City & State Did You Graduate? Course of Study/Degree/Certifications Actions Edit Delete There are no Schools. Add School Maximum number of schools reached. Personal ReferencesAdd References Name Business or Home Address Occupation Contact Phone Actions Edit Delete There are no References. Add Reference Maximum number of references reached. Upload Resume (Optional)Max. file size: 10 MB. Certification*I understand that if I am offered employment, it Is contingent upon satisfactorily passing a physical examination and/or drug test prior to placement in the position for which I have applied. I also understand that all information in this application may be checked and I hereby authorize any schools which I have attended, current and previous employers, and organizations named in this application to provide Barry County with any information that may be requested to make an employment decision. I further authorize Barry County to conduct any other Investigations of the Information contained herein. I hereby specifically waive written notice from any and all former employers regarding their disclosure to Barry County and any information, including disciplinary action. I understand that any omission or misrepresentation of information may be sufficient cause for rejection of this application or, If employment has commenced, grounds for immediate dismissal. I specifically authorize the Barry County Sheriff Department or other law enforcement agencies to release any records of prior criminal convictions it may have or may obtain from other sources to tho County of Barry. If hired, I promise to notify my Immediate supervisor in writing promptly, if any license, registration, certificate, or any other credential required for any job In which I become employed lapses, is suspended, revoked, or placed on probation for any reason. I recognize and agree that failure to provide such notice may result in immediate dismissal. Furthermore, except with respect to potential grievances under any applicable collective bargaining agreement, I agree that any action or suit against the County, arising out of my employment including but not limited to, claims arising under State or Federal civil rights statutes, must be brought within 180 days of the event giving rise to the claim(s) or be forever barred. I waive any limitations to the contrary. I understand and agree that in the absence of an express written agreement to the contrary executed by the employer, any employment I accept shall be for an Indefinite term and shall be terminable at any time; with or without notice or cause. either by me or at the will and sole discretion of the employer. I have read, or have had read to me, and understand the above statement. I hereby certify that all information contained in this application is true, complete and accurate. APPLICATIONS WITHOUT SIGNATURES WILL NOT BE CONSIDERED FOR EMPLOYMENT. Thank you for considering Barry County as a potential employer. I Have Read and Agree to These TermsSignature*CAPTCHA
