Buffalo County Employment Opportunities Job Application

Application for Employment

This application is good for 90 days or until the position is filled.

Buffalo County is an Equal Employment Opportunity Employer. Buffalo County assures equal employment opportunity to applicants and employees in all aspects of personnel administration without regard to political affiliation, race, color, national origin, sex, age, marital status, pregnancy, mental or physical disability, genetic information, religion, military status, or any other prohibited basis of discrimination, as provided under applicable state and federal law.

Federal law obligates us to provide reasonable accommodation to the known disabilities of applicants and employees, unless to do so would pose an undue hardship. Please feel free to let us know if you need an accommodation to complete the application process or to perform any essential elements of the position sought.

Applicant Details
Applicant's Name

First Name
Middle Initial
Last Name

Address

Street Address
Street Address 2
City	State
Zip Code	Country

Phone
Work phone
Are you legally authorized to work in the United States?

Yes No
If hired, you will be required to submit documents sufficient to establish employment authorization and identity in compliance with the Immigration Reform and Control Act of 1986. While you need not provide this proof of citizenship or immigration status at the time you are interviewed, please be prepared to assure us that you can do so immediately upon being hired if you receive an offer of employment.
This position is subject to a veterans preference. Are you eligible for and requesting a veterans preference?

Yes No
A veteran requesting preference must submit with his/her Application for Employment a copy of the veteran’s Department of Defense Form 214. A spouse of a veteran requesting preference must submit with his/her Application for employment a copy of the veteran’s Department of Defense Form 214, a copy of the veteran’s disability verification from the United States Department of Veteran Affairs demonstrating a 100 percent permanent disability rating, and proof of marriage to the veteran.
Position Info
Type of work desired (check all that apply)

Full-time Part-time Regular Temporary
Have you ever been employed here before?

Yes No
What dates were you employed?
Have you filed an application here before?

Yes No
When did you filed your past application?
Position applying for
Date available for work
Month - Day - Year
How did you learn about the job you have applied for? (be specific as to the source)
Previous Employment
List below the positions you have held, starting with your present employment. If more than one position or classification has been held with a given organization, list each position or classification as a separate period of employment. Under "Specific Duties," describe clearly the tasks you performed and the nature of your supervisory, technical, or other responsibilities. Please be complete. Your employment history may be verified by contacting previous employers. Volunteer, military, or unpaid experience will be evaluated in the same manner as paid employment and should be entered in the same manner. If you need more space, attach a separate sheet of paper. Please exclude organization names that indicate, for example, race, color, religion, sex, disability, or national origin
Previous Employment #1
Employer / type of business
Employer address
Immediate supervisor + job title
Phone number
Job type

Part-time Full-time
Your position title
Specific duties
Start date of employment (month & year)
End date of employment (month & year)
Starting hourly rate / salary
Final hourly rate / salary
Reason for leaving
Previous Employment #2
Employer / type of business
Employer address
Immediate supervisor + job title
Phone number
Job type

Part-time Full-time
Your position title
Specific duties
Start date of employment (month & year)
End date of employment (month & year)
Starting hourly rate / salary
Final hourly rate / salary
Reason for leaving
Previous Employment #3
Employer / type of business
Employer address
Immediate supervisor + job title
Phone number
Job type

Part-time Full-time
Your position title
Specific duties
Start date of employment (month & year)
End date of employment (month & year)
Starting hourly rate / salary
Final hourly rate / salary
Reason for leaving
Education & Skills
Please list education or specialized experience that relates to the position(s) for which you are applying. Exclude names or terms that indicate, for example, race, color, religion, sex, disability, or national origin.
Select highest grade completed

6 7 8 9 10 11 12
Select highest college year completed

1 2 3 4 5 Others
Did you graduate?

Yes No
Post-High School Education
College/University
Name of school
From
To
Major
Degree type
Graduate School
Name of school
From
To
Major
Degree type
Skills & Experience
If required by the job you have applied for, have you had training/course work or experience in (please check those that apply)

Typing Data Entry Calculator/Adding Machine Shorthand/Speedwriting
Word Processing PC/Computer Terminal Dictation Equipment
Please list any other types of equipment you can operate or skills you possess, which you feel would be an asset in the position for which you are applying
Licenses & Certificates
If a license, certificate, or other authorization to practice a trade or profession is required for the position for which you are applying, complete the following questions:
Name of trade or profession
License number
Granted by
City or State
Specialty
Licensed from:
Licensed to:
Applicant's Statement
These answers are true and complete to the best of my knowledge. I understand that any false, omitted, or misleading information in connection with this application or during the interview process will result in rejection of my application or termination of my employment if I am hired, regardless of when discovered.

I also understand that any offer of employment may be conditioned upon a health evaluation by a doctor selected by the County to determine whether I can perform the job duties. In addition, I understand a drug or alcohol test may be required, depending upon County policy. I authorize the County to make a thorough investigation of my past employment, education, criminal history, job-related activities, and other relevant background information, and I release from all liability all persons, companies, and corporations providing such information, either in writing or orally. I also indemnify this County against any liability that might result from making such investigation.

Additionally, I authorize the County to supply my employment record, in its sole discretion, in whole or in part, to any prospective employer, government agency, or other party with an interest that the County deems appropriate.

Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create a contract between Buffalo County and myself for either employment or for the providing of any benefit arising from employment. No promises regarding employment have been made to me. I understand that if an employment relationship is established, I have the right to terminate my employment at any time and Buffalo County retains the same right, regardless of any oral representations to the contrary. Any changes in this “at will” employment relationship must be made in writing and approved by the County Board.
Applicant's Signature
Date
Month - Day - Year

Typing	Data Entry	Calculator/Adding Machine	Shorthand/Speedwriting
Word Processing	PC/Computer Terminal	Dictation Equipment

Buffalo County Employment Opportunities Job Application

Application for Employment

Applicant Details

Position Info

Previous Employment

Previous Employment #1

Previous Employment #2

Previous Employment #3

Education & Skills

Post-High School Education

Skills & Experience

Licenses & Certificates

Applicant's Statement