Application For Employment Form - Horry County Government - Human Resources Department
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1
2HORRY COUNTY GOVERNMENT
HUMAN RESOURCES DEPARTMENT
P.O BOX 997
CONWAY, SC 29528-0997
(843) 248-1206
APPLICATION FOR EMPLOYMENT
PERSONAL DATA
Name:_________________________________________________________________ Social Security No. ____________________
First
Middle
Last
Mailing Address: ____________________________________________________________________________________________
Street
P.O. Box /Apt. #
City
State
Zip Code
Telephone: (Home) _________________________ (Work) _________________________ May we call you at work? YES
NO
Do you presently have relatives employed with Horry County?
YES
NO
If yes, name and department where employed_________________________________________
In case of emergency, please contact ______________________________ at Telephone Number: (
) ______________________
Are you authorized to work in the United States?
YES
NO
Have you ever been convicted of a crime other than minor traffic violations?
YES
NO
A yes answer to this question will not necessarily bar you from employment.
If yes, charge(s) _________________________________________ where convicted ______________________________________
date(s) ______________________________ disposition or current status _____________________________
EMPLOYMENT STATUS
Position applied for ____________________________________________________________
Is there a minimum salary you will accept? YES
NO
If yes, $ ____________________ per ________
Earliest date you could begin work (Month) ______________ (Day) __________ (Year) __________
EDUCATION AND SKILLS
Starting with high school, provide the complete information on all schools attended. Include special courses or trade school.
COMPLETED
NAME & LOCATION
DATES OF ATTENDANCE
CREDIT HOURS
GRADUATE
NAME OF
MAJOR/
OF SCHOOL
FROM
TO
SEM.
QTR
YES
NO
DEGREE/CERT
MINOR
HIGH SCHOOL/GED
TEC/COLLEGE
OTHER
List any other job-related skills you possess
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Do you possess a valid Driver's License (Answer only if required for position)
YES
NO
Do you possess a valid CDL (Answer only if required for position)
YES
NO
HORRY COUNTY GOVERNMENT REQUIRES A PRE-EMPLOYMENT PHYSICAL, INCLUDING A DRUG TEST. HORRY
COUNTY GOVERNMENT DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, RELIGION, GENDER, NATIONAL
ORIGIN, AGE, OR DISABILITY
August 1999
EMPLOYMENT RECORD
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