Linn County Online Employment Application

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, gender, religion, national origin, disability, or other protected classification. If you need any assistance in completing this form please let us know.

Online Job Application Form

Date of Application *

First Name *

Last Name *

Street Address *

City *

State *

Zip *

Position Applied For

Home Telephone # *

Business or Message #

Email *

Are you a US citizen or are you authorized by the INS to work in this country?

Yes

Are you 18 years old or older?

Yes

Have you ever been convicted of a felony?

Yes

Are you currently employed?

Yes

May we contact your present employer?

Yes

Are you willing to work overtime if required?

Yes

Are you capable of performing the essential functions of the job for which you have applied?

Yes

Do you have a high school diploma or GED?

Yes

Do you have a valid driver's license?

Yes

Do you have a valid CDL?

Yes

Are you related to any current Linn County Employees?

Yes

If so, who?

What is your relation?

Driver's License #

Who referred you to us?

Date available for work

Are you available to work:

Employment Experience
Start with your present or last job.

Employer 1

Address

Telephone #

Reason for Leaving

Work Performed

Dates Employed:

From

Hourly Rate:

Starting

Ending

Employer 2

Address

Telephone #

Reason for Leaving

Work Performed

Dates Employed:

From

Hourly Rate:

Starting

Ending

Employer 3

Address

Telephone #

Reason for Leaving

Work Performed

Dates Employed:

From

Hourly Rate:

Starting

Ending

SKILLS & QUALIFICATIONS

Summarize any training, skills, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

skills

EDUCATIONAL BACKGROUND

High School Name & Location

Years Completed

Did You Graduate?

Yes

Course of Study

College Name & Location

Years Completed

Major

Degree

Course of Study

Other Name & Location

Years Completed

Did You Graduate?

Yes

Course of Study

REFERENCES

Name

Telephone #

Years Known

Name

Telephone #

Years Known

Name

Telephone #

Years Known

I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer's service, whenever it is discovered.

I give the employer the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.

The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state, or federal law.

This application is current for only 60 days.

This application does not constitute an agreement or contract for employment for any specified period or definite duration.

I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

Signature (typed)

Date

LINN COUNTY AUTHORIZATION TO PERFORM BACKGROUND CHECK

(Initial each item if approved)

I understand that Linn County may do a background check for security reasons, including, but not limited to, a check of criminal records and verification of my identity.

I grant permission for Linn County to do the above described background check.

I willingly provide the following information necessary to perform the described background check and I understand that this information will be used solely for the purpose of doing the described background check and will not otherwise be used to evaluate my application. I understand that this form will be kept separate from my application from unless and until I have been offered employment by Linn County.

Name (First)

Last

Other Names I have Gone By

Date of Birth

Social Security Number

Driver's License or ID #

State DL or ID Issued From

Current Street Address

City

State

Zip

Previous Street Address

City

State

Zip

Signature (Typed)

Date

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