Fillable Printable Application for Employment - Missouri
Fillable Printable Application for Employment - Missouri
Application for Employment - Missouri
STATE OF MISSOURI
APPLICATION FOR EMPLOYMENT
“AN EQUAL OPPORTUNITY EMPLOYER”
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MO 300-0739 (1-99)
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Please type or print in ink. Your application must
be completed in its entirety to be considered.
FOR AGENCY USE ONLY
IDENTIFICATION
EDUCATION
CERTIFICATES/LICENSES
NAME (LAST, FIRST, MIDDLE)
PRESENT MAILING ADDRESS (STREET AND NUMBER OR RFD)
CITY STATE ZIP CODE SOCIAL SECURITY NUMBER
TELEPHONE NUMBERS WHERE YOU CAN BE CONTACTED REGARDING EMPLOYMENT HOME TELEPHONE NUMBER
( ) ( ) ( )
OTHER NAMES IN WHICH EMPLOYMENT, MILITARY OR EDUCATION RECORDS MAY BE FOUND COUNTY AND STATE OF LEGAL RESIDENCE
HIGH SCHOOL OR GENERAL EDUCATION DEVELOPMENT (GED) TEST PASSED?
YES NO
SCHOOL
LOCATION (CITY AND STATE)
CIRCLE HIGHEST GRADE COMPLETED
123456789101112
POST HIGH SCHOOL TRAINING (COLLEGE, BUSINESS SCHOOL, MILITARY, ETC.)
IF MORE SPACE IS NEEDED, ATTACH ADDITIONAL SHEETS OF PAPER
INDICATE SEMESTER HOURS COLLEGE CREDIT IN THESE AREAS:
COPY OF TRANSCRIPT MUST BE ATTACHED
COPY OF CERTIFICATE/LICENSE MUST BE ATTACHED
SKILLS
NAME AND LOCATION
CREDITS EARNED
QUARTER
HOURS
SEMESTER
HOURS
DEGREE
TYPE
MAJOR/MINOR
(ATTACH YOUR TRANSCRIPTS)
Business Computer Political
_____
Accounting
_____
Administration
_____
Science/Information
_____
History
_____
Science
_____
Social Work
_____
Agriculture
_____
Chemistry
_____
Economics
_____
Journalism
_____
Psychology
_____
Sociology
Biological Criminal
_____
Sciences
_____
Justice
_____
Education
_____
Mathematics
_____
Recreation
_____
Statistics
If you are currently certified, registered, or licensed to practice a profession or occupation, give the following:
LICENSE/CERTIFICATE
ISSUED BY
FIELD/TRADE/
SPECIALIZATION
LICENSE/CERTIFICATE
NUMBER
DATE OF
ISSUE
EXPIRATION
DATE
WHAT OFFICE EQUIPMENT CAN YOU OPERATE EFFICIENTLY?
LIST SOFTWARE AT WHICH YOU ARE PROFICIENT
TYPING SPEED SHORTHAND SPEED DATE OF LAST TEST NAME OF ADMINISTERING ORGANIZATION
NET WPM WPM
MO 300-0739 (1-99)
EXPERIENCE RECORD (PAID AND VOLUNTEER)
• List your work experience, starting with the most recent. If you have more than one job with the same organization, list each separately. The information
you give in the “Duties” section is used to determine your qualifications. For those Merit System jobs which require an education and experience rating,
this information is the basis for that rating. Incomplete descriptions may result in your not being qualified or in lower ratings.
• To describe additional experience or add more detail to the “Duties” section, complete a blank sheet of paper using the same format as used here and
identify the job to which it relates. A RESUME MAY NOT BE SUBSTITUTED FOR INFORMATION REQUESTED BELOW.
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR TO: MO/YR
HOURS PER WEEK LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?
YES NO
REASON FOR LEAVING
DUTIES
SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
TOTAL
100%
IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR TO: MO/YR
HOURS PER WEEK LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?
YES NO
REASON FOR LEAVING
DUTIES
SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
TOTAL
100%
IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR TO: MO/YR
HOURS PER WEEK LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?
YES NO
REASON FOR LEAVING
DUTIES
SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
TOTAL
100%
IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
MO 300-0739 (1-99)
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR TO: MO/YR
HOURS PER WEEK LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?
YES NO
REASON FOR LEAVING
DUTIES
SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
TOTAL
100%
IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR TO: MO/YR
HOURS PER WEEK LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?
YES NO
REASON FOR LEAVING
DUTIES
SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
TOTAL
100%
IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR TO: MO/YR
HOURS PER WEEK LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?
YES NO
REASON FOR LEAVING
DUTIES
SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
TOTAL
100%
IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
Additional space for your experience is available on the back of this form.
MO 300-0739 (1-99)
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR TO: MO/YR
HOURS PER WEEK LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?
YES NO
REASON FOR LEAVING
DUTIES
SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
TOTAL
100%
IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
PERSONAL DATA
APPLICANT CERTIFICATION
AUTHORIZATION FOR RELEASE OF INFORMATION
A. Have you ever been convicted of a felony? YES NO
List all such cases in the “Remarks” section and in each case give:
1. The date, court, and county location;
2. The nature (type) of offense or violation (stealing, burglary, etc.);
3. The penalty imposed (disposition)
Conviction of a violation of the law is not an automatic bar to employment. Each case is considered on its individual merits; however,
falsification of the application will result in disqualification. (Suspended execution of a sentence is a conviction.)
B. Are you authorized to work in the U.S.? YES NO
C. Are you willing to travel if position requires it? YES NO
REMARKS
I hereby certify that this application contains no willful misrepresentation or falsifications and that the information given by me is true and
complete to the best of my knowledge and belief. I am aware that should investigation at any time disclose any such misrepresentation
or falsification as to a material fact, my application will be rejected, I will be dismissed from the service and, if applicable, my name will
be removed from the Merit System register.
I hereby authorize my previous employers or any educational institutions I have attended to release to the State of Missouri’s authorized
representative any information they may have regarding my character, academic record or employment history, whether on record or not.
I also authorize any enforcement agency, or the Department of Revenue or other motor vehicle regulatory agency to allow any authorized
representative of the State of Missouri to examine, copy or receive any records pertaining to me regarding convictions or driving record.
By authorizing the above, I agree to hold harmless any individual, partnership, corporation, educational institution or agency, its officers,
agents and employees from any liability for any damage whatsoever for issuing such information.
SIGNATURE DATE
SIGNATURE DATE
