Job Application Step 1 of 5 20% Equal access to programs, services and employment is available to all persons. Those applicants requiring accommodation to the application and/or interview process should notify the Holmes County Highway Department. We consider all applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.Position(s) Being Applied for:*Date of Application* Date Format: MM slash DD slash YYYY How did you hear about this position?*AdvertisementRelativeInquiryWebsiteFriendEmployment AgencyOtherPlease Specify:Name* First Middle Last Address* Street Address City State / Province / Region ZIP / Postal Code Phone Number*Mobile PhoneEmail Address* When is the best time to contact you?*MorningEveningHave you ever submitted an application to Holmes County?*NoYesWhen did you submit an application?Have you ever been employed by Holmes County?*NoYesWhen were you employed by Holmes County?Are you legally eligible for employment in the United States?*YesNoIf you are under 18, can you furnish a work permit?YesNoDo you have a valid driver’s license?*Select OneYesNoState/License No.Are you able to meet all of the attendance requirements of the position(s)?*Select OneYesNoAre you able to work overtime if necessary?*Select OneYesNoWill you travel if the position requires it?*Select OneYesNoDo you have any friends / relatives currently employed by Holmes County?*Select OneYesNoWhat are their names/positions?What is your desired salary range or rate of pay per month?*Date Available for Work?* Date Format: MM slash DD slash YYYY Type of employment desired?*Full TimePart TimeSeasonal Starting with your most recent employer, provide the following information. Include any relevant volunteer activities, but exclude any organizations that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve National Guard or any other similarly protected status.Employer/OrganizationEmployment Began Date Format: MM slash DD slash YYYY Employment Ended Date Format: MM slash DD slash YYYY Address Street Address City State / Province / Region ZIP / Postal Code Phone NumberJob TitleSupervisor's NameMay we contact them?Select OneYesNoJob Duties/ResponsibilitiesReason for Leaving?Final SalaryEmployer/OrganizationEmployment Began Date Format: MM slash DD slash YYYY Employment Ended Date Format: MM slash DD slash YYYY Address Street Address City State / Province / Region ZIP / Postal Code Phone NumberJob TitleSupervisor's NameMay we contact them?Select OneYesNoJob Duties/ResponsibilitiesReason for Leaving?Final SalaryEmployer/OrganizationEmployment Began Date Format: MM slash DD slash YYYY Employment Ended Date Format: MM slash DD slash YYYY Address Street Address City State / Province / Region ZIP / Postal Code Phone NumberJob TitleSupervisor's NameMay we contact them?Select OneYesNoJob Duties/ResponsibilitiesReason for Leaving?Final SalaryPlease explain any gaps in employmentHave you ever been fired or asked to resign from a job?*Select OneYesNoPlease Explain High School Name/CityCourse of StudyYears CompletedDiploma/Degree ObtainedCollege Name/CityCourse of StudyYears CompletedDiploma/Degree ObtainedGraduate Professional Name/CityCourse of StudyYears CompletedDiploma/Degree ObtainedOther EducationCourse of StudyYears CompletedDiploma/Degree ObtainedPlease list any relevant professional or trade organizations of which you are a member. Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve National Guard or any other similarly protected status.Organization Name(s)Offices HeldPosition InterestPlease discuss your interest in employment with Holmes County and any qualifications beyond what is reflected in your application. Use additional sheets if needed. Please provide the names and telephone numbers of three professional references who are not related to you and are not previous supervisors. If professional references are not available, provide school or personal references who are not related to you.Name First Last Title:Relationship:PhoneEmail Name First Last Title:Relationship:PhoneEmail Name First Last Title:Relationship:PhoneEmail I certify that all information I have provided in order to apply for and obtain employment with Holmes County is true, complete, and correct. I agree and understand that omissions, misstatements, and falsifications will cause forfeiture on my part of all eligibility to any employment with Holmes County and may be cause for rejection of this application, removal of my name from eligibility lists, or discharge from County service, whenever it is discovered. I give Holmes County the right to investigate and verify any information obtained through the application process. Permission is granted and I release from any and all liability any employer, agency or individual assisting Holmes County in providing relevant, job-related information that will assist in this process. I expressly authorize, without reservation, Holmes County, its representatives, members or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application. I hereby waive any and all rights and claims I may have regarding Holmes County, its agents, members or representatives, for seeking, gathering, and using such information and all other persons, corporations, or organizations for furnishing such information about me. I understand that an offer of employment may be contingent upon the successful completion of a pre-employment background criminal investigation, physical, psychological, polygraph, and/or drug and alcohol screen. If employed, I agree to provide proof of identity, relevant licensure or credentials, and authorization for employment in the United States. If I am hired, I understand that, unless otherwise defined by applicable law, any employment relationship with Holmes County is of an “at will” nature, which means that I am free to resign at any time and Holmes County reserves the same right to terminate my employment at any time. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that all conditions of employment including, but not limited to hours, benefits and salary are subject to change by Holmes County at any time. I understand that no representative of Holmes County is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the appropriate Appointing Authority. DO NOT SIGN UNTIL YOU READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.Applicant SignatureDate Date Format: MM slash DD slash YYYY This iframe contains the logic required to handle Ajax powered Gravity Forms.