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Applicant information

OFFICE OF HUMAN RESOURCES
602 CRYSTAL AVENUE
DENTON, MD 21629
PHONE: 410-479-4105
FAX: 410-479-4023
Job Application
Applicant Information
Last Name*
First Name*
Middle Initial
Email Address*
Street Address*
Home/Cell Telephone Number*
City*
State*
Zip Code*
Position Information
Title of Position Applied For*
ALL APPLICANTS MUST ANSWER THE FOLLOWING QUESTIONS:
1. Are you legally eligible for employment in the United States of America? (If hired by Caroline County, you will be required to furnish proof of your eligibility for employment in the United States of America.)*
1. Yes
2. No
2. Are you over the age of eighteen (18) years? (If your answer is "no", your employment is conditioned upon verification that your are of a minimum legal age to be employed in the position for which you have applied).)*
1. Yes
2. No
3. Have you ever been asked to resign or resigned from a position in lieu of being fired? (If your answer is "yes", please give the employer, the position you held, the reason for the employer's action and the date you left employment.)*
1. Yes
2. No
If answer to Question 3 is yes, enter below:
4. Are you able to perform the essential functions of the job for which you are applying with or without reasonable accomodation?*
1. Accommodation Not Required
2. Accommodation Required
If answer to Question 4 is Accomodation Required, explain below:
5. If selected for employment, on what date are you available to begin work?
Date Available*
Date Available Start Date
—
Date Available End Date
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Vehicle License

Motor Vehicle License Information
You need to only answer this question if the minimum qualifications for the position you are applying for include possession of a motor vehicle operator's license.
Do you have a valid motor vehicle operator's license issued by the State of Maryland or the ability to acquire one within thirty (30) days after employment?*
1. No
2. Yes
If Yes to License, please enter following
License (Soundex) Number:
Issuing State:
Expiration Date:
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Certifications

Professional Certification
You need to only answer this question if the minimum qualifications for the position you are applying for include possession of specific professional certification (PE, Law Enforcement, Etc).
Do you have the required certification or the ability to acquire it within the required period?*
1. No
2. Yes
If Yes to Certification, please enter following
Certification Type:
Certification Number:
Issuing State:
Expiration Date:
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Education Information

Educational Information
High School
Name and Address of High School
Course of Study
Years Completed
Did You Graduate
1. Yes
2. No
Give Degree or Degrees
College
Name and Address of College
Course of Study
Years Completed
Did You Graduate
1. Yes
2. No
Give Degree or Degrees
Other (Specify)
Name and Address of College
Course of Study
Years Completed
Did You Graduate
1. Yes
2. No
Give Degree or Degrees
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Business References

Business References
Give the names of three (3) persons who are not related to you and can attest to your work history, reliability and abilities.
Reference Name 1*
Street Address
City, State, Zip
Telephone Number*
Reference Name 2*
Street Address
City, State, Zip
Telephone Number*
Reference Name 3*
Street Address
City, State, Zip
Telephone Number*
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Employment History

Employment History
Beginning with the present or latest employer, all applicants must provide the following information for all employers during the (7) years before the date of the application. (If more space is required to include all employers during the past (7) years, applicants may make a copy of page 3 before completing it and attach the additional page(s) to the application)
Most Current Employer:
Employer*
Position Title*
Address
City
State
Zip
Telephone Number*
Name of Immediate Supervisor*
Employed From*
Employed From
Employed To*
Employed To
Are you presently employed by this employer?*
1. Yes - May we contact your current employer for a reference check?
2. No
If no, give your reasons for leaving
List the top three essential function of your job with this employer:*
Did this employer use a performance evaluation system?*
1. Yes
2. No
If Yes, what was your last evaluation, when did you receive it?
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Second Employer

Second Most Current Employer:
Employer
Position Title
Address
City
State
Zip
Telephone Number
Name of Immediate Supervisor
Employed From
Employed From
Employed To
Employed To
Are you presently employed by this employer
1. Yes- May we contact your current employer for a reference check?
2. No
If no, give your reasons for leaving
List the top three essential functions of your job with this employer:
Did this employer use a performance evaluation system?
1. Yes
2. No
If Yes, what was your last evaluation, when did you receive it?
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Third Employer

Third most Current Employer:
Employer
Position Title
Address
City
State
Zip
Telephone Number
Name of Immediate Supervisor
Employed From
Employed From
Employed To
Employed To
Are you presently employed by this employer?
1. Yes - May we contact your current employer for a reference check?
2. No
If no, give your reasons for leaving
List the top three essential functions of your job with this employer:
Did this employer use a performance evaluation system?
1. Yes
2. No
If yes, what was your last evaluation, when did you receive it?
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Fourth Employer

Fourth Most Current Employer:
Employer
Position Title
Address
City
State
Zip
Telephone Number
Name of Immediate Supervisor
Employed From
Employed From
Employed To
Employed To
Are you presently employed by this employer?
1. Yes - May we contact your employer for a reference check?
2. No
If no, give your reasons for leaving
List the top three essential functions of your job with this employer:
Did this employer use a performance evaluation system?
1. Yes
2. No
If yes, what was your last evaluation, when did you receive it?
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Recognition & Awards & Knowledge/Skills

Employee Recognition and Awards
Have you ever received an award for outstanding job performance or a specific job related act?
1. Yes
2. No
Explain, giving the date, basis for the award, and attach a copy or copies of documents evidencing such awards to your application.
Knowledge, Skills, and abilities
Please list and describe the knowledge, skills and abilities which you possess and which you believe will assist you in performing the tasks and functions for which you have applied.*

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Applicant information

Vehicle License

Certifications

Education Information

Business References

Employment History

Second Employer

Third Employer

Fourth Employer

Recognition & Awards & Knowledge/Skills