Careers

Apply for a Position

Your Name(Required)

First Last

Your Email Address(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State ZIP Code

Cell Phone(Required)

Primary

Home Phone

Secondary

Best Time To Call You

When is the best time for us to reach you via telephone?

Date of Birth(Required)

MM slash DD slash YYYY

Last 4 of SSN(Required)

Please enter a number from 0000 to 9999.

Position Applied For(Required)

Position Reference Number

Are you currently employed?(Required)

Yes

Are you a U.S. citizen or are you otherwise legally eligible for employment in the U.S.?(Required)

(Anyone offered employment is required to provide proper identification and documentation of eligibility for employment in the U.S.)

Yes

Have you ever worked for the County of Buchanan?(Required)

Yes

If YES, please give dates of employment.

MM slash DD slash YYYY

From

MM slash DD slash YYYY

Have you ever been convicted of an adult law violation?(Required)

Yes

If yes, please give date, place, charge, court, and any fine or sentence imposed.

A conviction does not automatically mean that you cannot be employed. The nature of the offense and when it occurred will be considered, but you MUST give all of the facts. (Attach a separate sheet if necessary.)

Do you have a valid commercial driver’s license?

Yes

(Answer only if required for the position)

Do you have a valid driver’s license?

Yes

(Answer only if required for the position)

Do you have a high school diploma?(Required)

Yes

Other

(Either a regular diploma or G.E.D.) If NO, please list highest grade completed in school.

Places of Education(Required)

Please list name, location, dates, Credit Hours, Major Feild of Study, and if a degree was received for wherever you may have gone to College.

List specific college courses you have completed, which are related to the minimum requirements of the position for which you are applying (Indicate credit/non-credit). Also, please list any academic honors or awards you have received.

List education or training not covered above (such as vocational school, correspondence courses, & in-service training) which you feel relates to the position for which you are applying.

Special qualifications relevant to the position for which you are applying that are not covered elsewhere in your application (such as foreign language proficiency, professional licenses or certificates, skills in the operation of machinery, equipment, technical skills and/or computer, or other special training). For licenses and certificates, please include date, place of issuance, and date of expiration.

Previous Employment

PLEASE NOTE: In order to receive maximum consideration, list you present and past full-time, part-time, and temporary employment. Give special attention to experiences relating to the position for which you are applying. List related volunteer work, self-employment, and military service. You need not go back beyond 10 years, unless you feel prior experiences are directly related to the position. If more space is needed, attach additional pages with the same information requested in blocks 1 through 4.

May we contact your current employer?(Required)

Yes

Current or Most Recent Employer 1

Job Title(Required)

Employer(Required)

Dates Employed(Required)

Location and Phone(Required)

Name and title of immediate supervisor & phone number(Required)

Dates of Employment (information MUST be complete) From: _____/_____/_____ To: _____/_____/_____ Starting salary: ________ Final salary: __________ Number of hours worked per week: __________ Number of employees you supervised (if applicable): _______

Dates of Employment (information MUST be complete)(Required)

Describe you duties, responsibilities, and accomplishments(Required)

Reason for Leaving(Required)

Previous Employer 2

Job Title

Employer

Dates Employed

Location and Phone

Name and title of immediate supervisor & phone number

Dates of Employment (information MUST be complete)

Describe you duties, responsibilities, and accomplishments

Reason for Leaving

Previous Employer 3

Job Title

Employer

Dates Employed

Location and Phone

Name and title of immediate supervisor & phone number

Dates of Employment (information MUST be complete)

Describe you duties, responsibilities, and accomplishments

Reason for Leaving

Previous Employer 4

Job Title

Employer

Dates Employed

Location and Phone

Name and title of immediate supervisor & phone number

Dates of Employment (information MUST be complete)

Describe you duties, responsibilities, and accomplishments

Reason for Leaving

hereby certify that all of the information in this application and attachments is true, and I understand that such information is subject to verification. I authorize and agree to take whatever steps are required to enable the County of Buchanan to obtain educational, employment, and criminal records in relation to my job application. I further agree and authorize upon receipt of a conditional offer of employment, to take whatever steps are required to enable the County of Buchanan to obtain medical records related to my job application. I also agree that if employed by the County of Buchanan, I will, as a condition of continued employment, authorize and take whatever steps are required to enable the County of Buchanan to make criminal records checks during the course of my employment. I acknowledge that any falsification of this application is grounds for disqualification. I also acknowledge that if I am employed, falsification is grounds for discipline, including dismissal. I understand that I may be required to pass various job-related examinations in order to be considered for employment, including a physical examination and a drug test, prior to my employment being official and complete. I also understand that, if employed by the County of Buchanan, I am required to serve a probationary period during which time my performance will be evaluated, and I may be terminated if my conduct or performance is not fully satisfactory. I further understand that if employed by the County of Buchanan, I am subject to termination for reasons of: a) program revision, b) budgetary constraints, or c) a disqualifying criminal record or drug test and that I may also be dismissed for any cause at any time during the course of my employment.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

NOTE: UNSIGNED APPLICATIONS MAY BE REJECTED WITHOUT FURTHER NOTICE. Buchanan County Head Start requires two (2) reference letters.