Application For Employment
PLATTE COUNTY, MISSOURI IS AN EQUAL OPPORTUNITY EMPLOYER
First Name *
Your answer
Last Name *
Your answer
Position(s) Applied For *
Your answer
Date of Application *
MM
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DD
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YYYY
Address *
Your answer
Email Address *
Your answer
Home/Mobile Telephone *
Your answer
Work Telephone *
Your answer
Social Security Number *
Your answer
If you are under 18 years of age, can you provide required proof of your eligibility to work?
Have you filed an application with Platte County Previously? *
If yes, when?
Your answer
Have you been employed by Platte County previously? *
If yes, when?
Your answer
Are you currently employed? *
May we contact your present employer? *
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? *
On what date would you be available for work? *
MM
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DD
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YYYY
Are you available to work: *
Required
Are you currently on "lay-off" status and subject to recall? *
Driver's License number (if driving is an essential job function)
Your answer
Do you have a CDL?
If yes, which class?
Your answer
Have you been convicted of a felony?
If yes, please explain:
Your answer
Is there any reason you could not perform the essential functions of the position for which you are applying without reasonable accommodations?
If yes, please explain
Your answer
EMPLOYMENT EXPERIENCE
START WITH YOUR PRESENT OR LAST JOB. INCLUDE ANY JOB-RELATED MILITARY SERVICE ASSIGNMENTS AND VOLUNTEER ACTIVITIES. YOU MAY EXCLUDE ORGANIZATIONS WHICH INDICATE RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, DISABILITIES, OR OTHER PROTECTED STATUS.
Employer 1
Employer Name
Your answer
Address
Your answer
Telephone Number
Your answer
Job Title
Your answer
Supervisor
Your answer
Reason for leaving
Your answer
Dates Employed
From
MM
/
DD
/
YYYY
To
MM
/
DD
/
YYYY
Hourly Rate/Salary
Starting
Your answer
Final
Your answer
Work Performed
Your answer
Employer 2
Employer Name
Your answer
Address
Your answer
Telephone Number
Your answer
Job Title
Your answer
Supervisor
Your answer
Reason for leaving
Your answer
Dates Employed
From
MM
/
DD
/
YYYY
To
MM
/
DD
/
YYYY
Hourly Rate/Salary
Starting
Your answer
Final
Your answer
Work Performed
Your answer
Employer 3
Employer Name
Your answer
Address
Your answer
Telephone Number
Your answer
Job Title
Your answer
Supervisor
Your answer
Reason for leaving
Your answer
Dates Employed
From
MM
/
DD
/
YYYY
To
MM
/
DD
/
YYYY
Hourly Rate/Salary
Starting
Your answer
Final
Your answer
Work Performed
Your answer
Employer 4
Employer Name
Your answer
Address
Your answer
Telephone Number
Your answer
Job Title
Your answer
Supervisor
Your answer
Reason for leaving
Your answer
Dates Employed
From
MM
/
DD
/
YYYY
To
MM
/
DD
/
YYYY
Hourly Rate/Salary
Starting
Your answer
Final
Your answer
Work Performed
Your answer
Education
Do you have a high school diploma or equivalent? *
If not, what is the highest grade you completed?
Your answer
PLEASE LIST ALL EDUCATION, BEGINNING WITH SCHOOL
High School:
Name and location
Your answer
Degree
Technical/Vocational:
Name and location
Your answer
Course of study
Your answer
Total hours
Your answer
Degree
College:
Name and location
Your answer
Course of study
Your answer
Total hours
Your answer
Degree
SKILLS AND CERTIFICATIONS
List all valid professional licenses and registrations you hold. Include the certification/registration number and the date of expiration.
Your answer
Indicate other employment skills, special training or additional information to consider regarding your application. (You may exclude all information indicative of age, sex, race, religion, color, national origin, or disability.)
Your answer
REFERENCES
PLEASE LIST THREE PEOPLE WHO WE MAY CONTACT TO VERIFY INFORMATION CONTAINED WITHIN THIS EMPLOYMENT APPLICATION.
Reference #1
First Name
Your answer
Last Name
Your answer
Phone Number
Your answer
Address
Your answer
Reference #2
First Name
Your answer
Last Name
Your answer
Phone Number
Your answer
Address
Your answer
Reference #3
First Name
Your answer
Last Name
Your answer
Phone Number
Your answer
Address
Your answer
Applicant's Statement
I CERTIFY THAT THE ABOVE STATEMENTS ARE CORRECT, AND IF EMPLOYED, UNDERSTAND THAT ANY FALSE INFORMATION IN THIS APPLICATION, OR ITS SUPPORTING DOCUMENTS, WILL BE SUFFICIENT GROUNDS FOR TERMINATION WITHOUT NOTICE. I FURTHER AGREE THAT ALL RULES, ORDERS AND REGULATIONS OF PLATTE COUNTY AFFECTING MY EMPLOYMENT SHALL CONSTITUTE A PART OF MY APPOINTMENT OR EMPLOYMENT.
I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT, UNLESS OTHERWISE DEFINED BY APPLICABLE LAW, ANY EMPLOYMENT RELATIONSHIP WITH PLATTE COUNTY IS OF AN "AT WILL" NATURE, MEANING THAT I CAN RESIGN AT ANY TIME AND THAT I MAY BE DISCHARGED AT ANY TIME, WITH OR WITHOUT CAUSE. IT IS FURTHER UNDERSTOOD THAT THIS "AT WILL" EMPLOYMENT RELATIONSHIP MAY NOT BE CHANGED BY ANY WRITTEN DOCUMENT OR BY CONDUCT UNLESS SUCH CHANGE IS SPECIFICALLY ACKNOWLEDGED IN WRITING BY AN AUTHORIZED EXECUTIVE OF PLATTE COUNTY.
MY SIGNATURE AUTHORIZES PLATTE COUNTY TO REVIEW MY PREVIOUS EMPLOYMENT, DRIVING AND CRIMINAL RECORDS, AND OTHER BACKGROUND DATA AS IT RELATES TO THE POSITION(S) FOR WHICH I AM APPLYING.
Electronic Signature
Platte County requires that you certify your application by submitting an electronic signature. To certify your application, provide an electronic signature (type your name) and enter today's date, then click Submit.
Signature *
Your answer
Date *
MM
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Submit
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This form was created inside of Platte County, Missouri.