Owen County Fiscal Court Application for Employment

College Year, Major and Degree
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* Indicates REQUIRED Field
Date of Application(*)

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Last Name(*)
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First Name(*)
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Middle Name
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Street Address(*)
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City(*)
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State(*)
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Zip Code(*)
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Home Phone(*)
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Cell Phone(*)
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Email Address:
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Position for which you are applying(*)
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How did you hear of this opening?(*)
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When can you start?(*)
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Desired Salary(*)
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Are you a US citizen or otherwise authorized to work in the US?(*)
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Are you looking for full-time employment?(*)
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If no, what hours are you available?
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Are you willing to work swing shift?(*)
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Are you willing to work graveyard shift?(*)
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Have you ever been convicted of a felony?(*)
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If yes, describe conditions:
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High School Name and Location:(*)
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HIgh School Year and Degree:(*)
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College Name and Location:
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College Name and Location:
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College Year, Major and Degree:
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Post college training and experience:
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Other Training:
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Any other skills, qualifications, experience or training we should consider?
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Employment Information
Employer Name(*)
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Employer Address:(*)
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Supervisor's Name:(*)
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Employer Phone Number:(*)
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May we contact this supervisor?(*)
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Start Date of Employment(*)
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End Date of Employment:(*)
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Starting Wage With This Employer?(*)
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Ending Wage With This Employer?(*)
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Starting Position With This Employer?(*)
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Ending Position With This Employer?(*)
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Work Responsibilities:(*)
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Reason for Leaving?(*)
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Employer Name
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Employer Address:
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Supervisor's Name:
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Employer Phone Number:
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May we contact this supervisor?
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Start Date of Employment
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End Date of Employment:
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Starting Wage With This Employer?
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Ending Wage With This Employer?
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Starting Position With This Employer?
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Ending Position With This Employer?
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Work Responsibilities:
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Reason for Leaving?
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Employer Name
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Employer Address:
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Supervisor's Name:
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May we contact this supervisor?
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Employer Phone Number:
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Start Date of Employment
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End Date of Employment:
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Starting Wage With This Employer?
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Ending Wage With This Employer?
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Starting Position With This Employer?
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Work Responsibilities:
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Ending Position With This Employer?
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Reason for Leaving?
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Employer Name
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Employer Address:
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Supervisor's Name:
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May we contact this supervisor?
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Employer Phone Number:
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Start Date of Employment
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End Date of Employment:
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Starting Wage With This Employer?
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Ending Wage With This Employer?
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Starting Position With This Employer?
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Work Responsibilities:
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Ending Position With This Employer?
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Reason for Leaving?
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A scanned copy or a picture of your driver's license is required(*)
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If you have a CDL or certifications, scanned copies or pictures of these are required.
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Attach additional information, if necessary. This could include resume, transcript, etc.
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Attach additional information, if necessary. This could include resume, transcript, etc.
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I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This fiscal court or its agent is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment with the Owen County Fiscal Court is "at will", which means that either I, or the fiscal court can terminate the employment relationship at any time, with or without prior written notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of the fiscal court, other than the county judge executive or fiscal court has any authority to alter the foregoing.
Electronic Signature(*)
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Date of Signature(*)

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Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this agreement. By selecting "I Accept" you consent to be legally bound by this agreement's terms and conditions.
(*)
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