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Fillable Printable application for employment instructions for Division of Personnel
Fillable Printable application for employment instructions for Division of Personnel
application for employment instructions for Division of Personnel
AP P LICATI O N FOR EMPLOYMENT
INSTRUCTIONS
The Division of Personnel paper application is essentially for current employees and/or former employees who
are applying for internal job postings.
FOR ALL OTHER APPLICANTS: You should apply online if at all possible. You may apply from any internet
connected computer. This may include your home, at many libraries, schools, and most Workforce WV Job
Services offices. Applying online speeds application processing. You should ONLY use a paper application if the
job announcement does not allow online applications, or you cannot complete the online application form.
These two instruction pages are not part of the application and should not be submitted with the completed
form. If you have any questions, please call our office at 304-558-3950, ext. 0.
Social Security Number Required: Pursuant to Section 7 of the Privacy Act of 1974, your disclosure of your social
security number is mandatory. We require social security numbers to verify your identity and confirm the
information you provide in your application. Failure to provide your social security number will result in
rejection of your application.
General Information: Information about testing, announced job titles, testing locations, and the employment
process are available on our website at www.personnel.wv.gov. The website also has a map of WV counties to
assist you in determining your availability area. You may also obtain information by calling our office and
speaking with a counselor. If you are planning to take a written examination and did not apply online, TAKE
your completed application to the examination center when reporting for testing. Do not mail an application for
a written examination to our office. Applications for jobs which do not require a written test should be mailed or
delivered to the address shown at the top of Page 1 of the form. If you apply online, you do not need to mail
your application or take it to the test site. A photocopy of the application with signature and current date is
acceptable. A resume cannot be substituted for the application.
Availability for Interview and Appointment (Very Important): In order to process your application, we must know
the counties in which you are willing to interview and accept employment. Space has been provided on the
Application for you to indicate the counties in which you are definitely available for work. A printable map is
available on our website showing the location of all counties.
Documentation of Training and Experience: Proof of degree(s), major fields of study, specific course work,
license(s), vocational, or other required training may be required. Please read the job posting for details. An
applicant’s test may be scored but will not be considered for employment until the required documents are
received. Copies of documents will be accepted providing all information is clearly shown. All employment listed
on the Application is subject to verification. Be sure to include all relevant experience (including military
experience) in the Employment History section. You MUST indicate“hours per week” for all work. All
employment dates MUST be complete and accurate.
Equal Employment Opportunity: The WV Division of Personnel assures all applicants of equal opportunity when
applying for employment. No applicant will be discriminated against based on race, sex, age, religion, national
origin, political affiliation, disability, or any other non-job related factors. Furthermore, it is a violation of state
law for any person to use any official authority or influence to attempt to secure for any person an advantage in
appointment to a position in the classified service. We provide all reasonable accommodations for persons with
disabilities. Call our office for assistance and information.
Military Service and Veterans Preference Eligibility Requirements: Before completing the Military Service and
Veteran’s Preference section of the application, you must read the following to determine your eligibility for
preference points. Only veterans meeting the eligibility requirements can receive preference. Applicants
claiming Veteran’s Preference points MUST provide a copy of their DD214 Form.
Eligibility Requirements: Five points shall be added to a final passing examination score of any person who
meets any ONE of the following conditions:
1. Served on active duty anytime between December 7, 1941 and September 7, 1980; OR
2. A Reservist called to active duty between February 1, 1955 and October 14, 1976 AND who served
for more than 180 days; OR
3. A Reservist who entered active duty between October 15, 1976 and October 13, 1982 AND:
a. a. received a campaign badge or expeditionary medal, OR
b. b. is a disabled veteran; OR
4. Enlisted in the Armed Forces after September 7, 1980 or entered active duty other than by
enlistment on or after October 14, 1982 AND;
a. completed 24 months of continuous active duty or the full period called or ordered to active
duty or was discharged under 10 U.S.C. 1171 or for hardship under 10 U.S.C. 1173 AND
received or was entitled to receive a campaign badge or expeditionary medal, OR
b. is a disabled veteran.
A Veteran may receive an additional 5 points if s(he) received a Purple Heart Award (verified by the DD214
Form), or if s(he) has a compensable, service-connected disability. The disability must be verified by a letter
from the Veteran’s Administration, dated within the last 6 months, indicating that the individual is currently
receiving disability compensation for a service-connected disability.
If you would like assistance in determining your eligibility, please call our office.
Be Sure to Sign Your Application: Unsigned Applications are returned. You may make a photocopy of your
completed application, but each application submitted must contain a signature and current date. If you have
any questions about completing the form please contact one of our counselors for assistance at 304-558-3950,
ext. 0.
These two pages of instructions are not part of the application.
Please do not submit them with your application.
Check the printed form to make sure all sections are complete.
West Virginia Division of Personnel March 18, 2014
Application for Employment Instructions Page 2 of 2
APPLICATION FOR EMPLOYMENT
1900 Kanawha Boulevard, East
♦
Charleston, West Virginia 25305-0139
♦
PH: 304-558-3950
♦
FAX: 304-957-0141
JOB CLASSES FOR WHICH YOU ARE APPLYING
Application cannot be processed without at least one job title
FOR OFFICE USE ONLY
Do not write in the spaces below
1.
2.
3.
4.
5.
1.
A
R
V-5
V-10
2. A R
3. A R DOP INITIALS
4. A R ________________
5.
A
R ________________
SOCIAL SECURITY NUMBER (See SSN note in instructions)
LAST NAME
FIRST NAME
MIDDLE INITIAL
STREET ADDRESS
CITY, STATE, and ZIP
COUNTY OF RESIDENCE
HOME PHONE
OTHER PHONE
EMAIL
MARK ALL EMPLOYMENT TYPES YOU WILL ACCEPT
ANSWER EACH OF THE FOLLOWING
Y
N
OFFICE USE
A
Permanent Full-Time
Have you applied to the Division of
Personnel in the last 12 months?
B
Permanent Part-Time
C
Temporary Full-Time
Have you applied to the Division of
Personnel using a different full or last
name? If yes, enter other name.
D
Temporary Part-Time
E
Intermittent
MARK ALL SHIFTS YOU WILL ACCEPT
A
Day Shift
Have you previousl
y held or do you
currently hold a job covered by the
Division of Personnel?
B
Evening Shift
C
Night Shift
D
Rotating Shift
Were you born in West Virginia? If
yes, enter county born in.
DATE AVAILABLE TO BEGIN INTERVIEWING
Have you been convicted of a felony in the past
seven years? Yes No
NOTE:
A ‘yes’ answer will not cause your name to be
removed from an employment register or bar you
from all employment unless the conviction relates to
the position for which you are applying.
Can you legally work in the U.S.? If
temporarily, enter expiration date.
May we send your name to agencies
that are not covered by the Division
of Personnel?
SELECT THE COUNTIES BELOW IN WHICH YOU WILL DEFINITELY ACCEPT EMPLOYMENT
01 Barbour
12 Grant
23 Logan
34 Nicholas
45 Summers
02 Berkeley
13 Greenbrier
24 McDowell
35 Ohio
46 Taylor
03 Boone
14 Hampshire
25 Marion
36 Pendleton
47 Tucker
04 Braxton
15 Hancock
26 Marshall
37 Pleasants
48 Tyler
05 Brooke
16 Hardy
27 Mason
38 Pocahontas
49 Upshur
06 Cabell
17 Harrison
28 Mercer
39 Preston
50 Wayne
07 Calhoun
18 Jackson
29 Mineral
40 Putnam
51 Webster
08 Clay
19 Jefferson
30 Mingo
41 Raleigh
52 Wetzel
09 Doddridge
20 Kanawha
31 Monongalia
42 Randolph
53 Wirt
10 Fayette
21 Lewis
32 Monroe
43 Ritchie
54 Wood
11 Gilmer
22 Lincoln
33 Morgan
44 Roane
55 Wyoming
ALL COUNTIES – Mark this option ONLY if you will accept employment in any county.
THE WEST VIRGINIA DIVISION OF PERSONNEL IS AN EQUAL OPPORTUNITY EMPLOYER
If you have a disability and need assistance or a reasonable accommodation, call our office at 304-558-3950.
EDUCATION: If you need additional space, provide the information on a separate sheet of paper.
Did you receive a high school diploma or GED equivalent?
High School Diploma
GED Equivalent
Neither
Mark highest grade completed:
1
2
3
4
5
6
7
8
9
10
11
12
Additional Education: All academic training other than High School/GED Equivalent must be verified. Verification of
academic training may be in the form of an official transcript, copy of diploma or certificate, or written statement from
an authorized agency verifying possession of the necessary credentials.
SCHOOL NAME
and ADDRESS
FIELD(S) of STUDY
CREDIT
HOURS
ATTENDANCE DATES
TYPE OF
DEGREE
ATTACH
TRANSCRIPT
major minor sem. qtr. mo./yr. mo./yr.
BUSINESS/VOCATIONAL/
TECHNICAL SCHOOL
COURSE(S) of STUDY
NO. WEEKS
ATTENDED
HOURS
PER DAY
CLOCK HRS.
COMPLETED
CERTIFICATE
ATTACH COPY
ADDITIONAL TRAINING
SEMINARS, MILITARY TRAIN., WORKSHOPS, ETC.
COURSE(S) of STUDY
NO. WEEKS
ATTENDED
HOURS
PER DAY
CLOCK HRS.
COMPLETED
CERTIFICATE
ATTACH COPY
LICENSE(S) (CDL, NURSE, SOCIAL WORK, ETC.) LICENSE NUMBER(S) - ATTACH COPY EXP. DATE (MM/YYYY) TYPE/CLASS (TEMP, CLASS A or B, ETC.)
MILITARY SERVICE and VETERANS PREFERENCE POINTS: Completion of this section is voluntary; however you must do
so if you are claiming Veterans Preference Points. To claim eligibility, you MUST also provide a copy of your DD214 Form.
Five (5) points shall be added to a final passing examination score for any person who meets the eligibility requirements.
Five additional points may be awarded if you received a Purple Heart Award or if you have a verified compensable
service-connected disability. Before completing this section, please read the Veterans Preference Eligibility Require-
ments information in the applications instructions.
Yes
No Are you claiming five Veterans Preference Points for service in the United States Armed Forces?
Are you claiming an additional five Veterans Preference Points based on:
Yes No A Purple Heart Award? (If yes, the award must be stated on the DD214 Form)
Yes No A verified compensable service-connected disability? (If yes, a Veterans Administration letter
dated within the past six months is required – see instructions)
IDENTIFICATION: When reporting for a written examination, you must present identification which includes a signature
and/or picture (i.e., valid driver’s license, Social Security card, credit card, passport).
AFFIRMATION: I certify under penalty of law and disqualification that all statements are true and complete. I authorize
the State of West Virginia and any agent acting on its behalf to conduct an inquiry into any job-related information
contained in this application. I release the State of West Virginia and any agent acting on its behalf from any and all
liability by reason of the request for such information. I further authorize and request each former employer educational
institution, or organization (including law enforcement agencies) to provide all information that may be sought in
connection with this application.
Yes
No If you are a male, age 18-25, have you registered, as required, with the U.S. Selective Service?
SIGNATURE: _____________________________________________________ DATE: ___________________________
West Virginia Division of Personnel – Application for Employment (Revised March 18, 2014) Page 2
EMPLOYMENT HISTORY: List all work experience beginning with your present/most recent employer and work back.
Changes in title, duties, or employment status with the same employer must be listed as separate jobs. Be sure to show
employment dates and hours worked per week, and for paid work, you must list a salary. If more space is needed to
describe your duties, continue into the next box. For more on this section, refer to the instruction pages. If more space is
needed for job duties, continue into next section or attach additional pages. IMPORTANT: Resumés are not accepted.
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
West Virginia Division of Personnel – Application for Employment (Revised March 18, 2014) Page 3
EMPLOYMENT HISTORY: List all work experience beginning with your present/most recent employer and work back.
Changes in title, duties, or employment status with the same employer must be listed as separate jobs. Be sure to show
employment dates and hours worked per week, and for paid work, you must list a salary. If more space is needed to
describe your duties, continue into the next box. For more on this section, refer to the instruction pages. If more space is
needed for job duties, continue into next section or attach additional pages. IMPORTANT: Resumés are not accepted.
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
West Virginia Division of Personnel – Application for Employment (Revised March 18, 2014) Page 4
EMPLOYMENT HISTORY: List all work experience beginning with your present/most recent employer and work back.
Changes in title, duties, or employment status with the same employer must be listed as separate jobs. Be sure to show
employment dates and hours worked per week, and for paid work, you must list a salary. If more space is needed to
describe your duties, continue into the next box. For more on this section, refer to the instruction pages. If more space is
needed for job duties, continue into next section or attach additional pages. IMPORTANT: Resumés are not accepted.
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
West Virginia Division of Personnel – Application for Employment (Revised March 18, 2014) Page 5
EMPLOYMENT HISTORY: List all work experience beginning with your present/most recent employer and work back.
Changes in title, duties, or employment status with the same employer must be listed as separate jobs. Be sure to show
employment dates and hours worked per week, and for paid work, you must list a salary. If more space is needed to
describe your duties, continue into the next box. For more on this section, refer to the instruction pages. If more space is
needed for job duties, continue into next section or attach additional pages. IMPORTANT: Resumés are not accepted.
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
West Virginia Division of Personnel – Application for Employment (Revised March 18, 2014) Page 6
EMPLOYMENT HISTORY: List all work experience beginning with your present/most recent employer and work back.
Changes in title, duties, or employment status with the same employer must be listed as separate jobs. Be sure to show
employment dates and hours worked per week, and for paid work, you must list a salary. If more space is needed to
describe your duties, continue into the next box. For more on this section, refer to the instruction pages. If more space is
needed for job duties, continue into next section or attach additional pages. IMPORTANT: Resumés are not accepted.
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
West Virginia Division of Personnel – Application for Employment (Revised March 18, 2014) Page 7
EMPLOYMENT HISTORY: List all work experience beginning with your present/most recent employer and work back.
Changes in title, duties, or employment status with the same employer must be listed as separate jobs. Be sure to show
employment dates and hours worked per week, and for paid work, you must list a salary. If more space is needed to
describe your duties, continue into the next box. For more on this section, refer to the instruction pages. If more space is
needed for job duties, continue into next section or attach additional pages. IMPORTANT: Resumés are not accepted.
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
West Virginia Division of Personnel – Application for Employment (Revised March 18, 2014) Page 8
EMPLOYMENT HISTORY: List all work experience beginning with your present/most recent employer and work back.
Changes in title, duties, or employment status with the same employer must be listed as separate jobs. Be sure to show
employment dates and hours worked per week, and for paid work, you must list a salary. If more space is needed to
describe your duties, continue into the next box. For more on this section, refer to the instruction pages. If more space is
needed for job duties, continue into next section or attach additional pages. IMPORTANT: Resumés are not accepted.
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
BUSINESS TYPE
SUPERVISOR’S NAME
YOUR JOB TITLE
LAST SALARY
EMPLOYMENT DATES (month/year)
From To
EMPLOYMENT STATUS
HOURS WORKED
Paid
Volunteer
Full-Time
Part-Time Hours Worked Per Week
SUPERVISORY EXPERIENCE
Did you supervise employees?
Yes
No Date you began supervising (month/year)
List title(s) and number(s) of employees you officially supervised
DETAILED DESCRIPTION OF YOUR JOB DUTIES
West Virginia Division of Personnel – Application for Employment (Revised March 18, 2014) Page 9
