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Upson County Employment Application

  1. .

    Document


    Upson County Employment Application

  2. Name
  3. Address
  4. Have you filled out an application here before?
  5. Have you been employed here before?
  6. Are you employed now?
  7. May we contact your present employer?
  8. Are you prevented from lawfully becoming employed in this country because of Visa or immigration status? (Proof of citizenship or immigration status may be required upon employment)*
  9. Are you available to work*
  10. Are you on lay-off and subject to recall?*
  11. Do you have a valid driver's license?*
  12. Are you able to travel if the job requires it?*
  13. Veteran of the U.S. Military Service?
  14. Special Employment Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals with Physical or Mental Handicaps.

    Government contractors are subject to section 402 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans of the Vietnam Era, and section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals.

    If you are a disabled veteran, or have a physical or mental handicap, you are invited to volunteer this information.  The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job in a proper and safe manner. This information will be treated as confidential.  Failure to provide this information will not jeopardize or adversely affect any consideration you may receive for employment.


  15. If you wish to be identified, please sign below:
  16. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  17. Employment Experience

    Start with your present or last job, include military service assignments and volunteer activities.  Exclude organization names which indicate race, color, religion, sex or national origin.

  18. Special Skills and Qualifications
  19. Education
  20. Years Completed (check all that apply)*
  21. Years Completed (check all that apply)*
  22. Years Completed (check all that apply)
  23. Years Completed (check all that apply)
  24. Agreement

    I certify that the 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 the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all of the rules and regulations of Upson County if I am employed.

  25. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  26. THIS APPLICATION WILL ONLY BE CONSIDERED FOR VACANCIES EXISTING ON OR WITHIN SIXTY (60) DAYS AFTER IT IS FILED WITH THE PERSONNEL OFFICE OF UPSON COUNTY.
  27. Upson County
  28. APPLICANT DATA RECORD

    Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition, handicap, or any other legally protected status.  As a governmental employer, we comply with all regulations and affirmative action responsibilities.

    The following information is required in order to comply with the permanent injunction referred to above.

  29. Applicant's Sex*
  30. Applicant's Race:*
  31. This information will be kept confidential and will only be utilized for the purposes required under applicable law.
  32. Leave This Blank:

  33. This field is not part of the form submission.