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Bay County Employment Application

Enter your information into the form below.
Name: * Required
Email Address: * Required
Phone Number: * Required
Date: 5/28/2017
Mailing Address: * Required
City: * Required
State: * Required
Zip: * Required
Position Desired: Date you can Start:
How did you find out about the vacancy?
Record of Education and Training
School Name & Location Course of Study Last Year Completed Did you Graduate? List Degree or Diploma
Elementary
High School
College
Trade or Business
Certifications
EXPERIENCE - Begin with your present or most recent job
Date Name & Location Wage or Salary Position Reason for Leaving
From:
To:
Starting:
Ending:
From:
To:
Starting:
Ending:
From:
To:
Starting:
Ending:
From:
To:
Starting:
Ending:
From:
To:
Starting:
Ending:
May we contact your current employer?
Are you requesting your application be held confidential under the Freedom of Information Act?
PERSONAL REFERENCES - Not relatives or former employers. Persons you have known within past year.
Name Address Phone Number
PERSONAL DATA
Are you currently working?
Are you prevented from lawfully becoming employed in this country because of VISA or immigrant status?
Are you a veteran of the armed forces?
Have you ever worked for Bay County under another name?
*If yes, what name?
Are you 18 years of age or older?
Do you have any relatives, other than a spouse, employed by Bay County?
*If Yes, list relative:
Have you ever been convicted of a felony?
*If Yes, list felony:
Have you ever been fired from a job?
Will you submit to a pre-employment drug screening?

Bay County is an equal opportunity employer. Employment selection and all other employment decisions are made without regard to race, color, religion, national origin, sex, disability, or handicap, age, height, weight, veteran status, marital status, or any other reason prohibited by law.

READ THOROUGHLY BEFORE SUBMITTING. IF YOU HAVE ANY QUESTIONS, PLEASE ASK BEFORE SIGNING.

I agree that any action or lawsuit against the employer, arising out of my employment or termination of employment, including, but not limited to, state or federal civil rights statutes, must be filed within 180 days of the event giving rise to the claim or be forever barred. I waive any limitation periods to the contrary.

I certify that the information contained in this application, and future information in support of my application, is correct and understand that falsification of this information is grounds for dismissal. I authorize the references I have provided and my former and/or current employer(s) to give you any and all information concerning my previous or current employment and any pertinent information that they may have, personal or otherwise, and release all parties from all liability for any damages, causes of actions, including, but not limited to, slander and libel, that may result from the furnishing of information. In consideration of my employment, I agree to conform to the rules and regulations of the employer and agree that my employment and compensation can be terminated, with or without cause, and with orwithout notice, at any time, and my employment relationship is at will. I understand that no manager or representative of the employer has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. I understand that any employment offer is conditional upon the results of the drug-screening test and the post-offer medical examination, if any. I authorize the employer to make a check of my records of driving violations and criminal history, if any. I have read, understand, and agree to the terms contained in the certifications listed herein.

Signature Confirm Signature:
Date 5/28/2017