Fillable Printable Employment Application Form - Maryland

Employment Application Form - Maryland

Do not fill this out if you have access to the internet! We have our application process online. Complete

one application, apply for multiple jobs. Find out the status of your application 24 hrs a day, 7 days a week!!

Receive email notifications of new job openings through our online interest file. An email address is all you

need. Free email accounts are available from various providers. Don’t have a computer? Public libraries

offer free access to computers or visit our State Employment Center at 301 W. Preston Street, Room 510A,

Baltimore, 21201.

You are required to provide the following information:

First 3 Letters of Last Name at Birth: _______Birth Month: ___________Birth Day: _____Last 4 digits of SSN: _____

Personal and Contact Information

Job Number: ______-_________-________ Job Title: _____________________________________

Name: _______________________________ ______________________________ ___________

Last First Middle

Address: __________________________________________________________________________

Number, Street and Apt

City: _____________________ County: _________________ State: ___________ Zip: ___________

Phone: __________________________ __________________________ ______________________

Primary Ok to leave msg? Work Ok to leave msg? Alternate Ok to leave msg?

Email Address: _____________________________________________________________________

How did you hear about this job opening? ________________________________________________

Employment Preference

Never been employed by the State of Maryland

Current employee of the State of Maryland

Former employee who has held employment with the State of Maryland in the past three years.

Former employee whose most recent employment with the State of Maryland was over three years ago

If a current/former employee of the State of Maryland, provide the following information at time of separation:

______________________________ ________________________________________

First Name Last Name

_________

(Provide the initial that is/was in employee record to ensure that appropriate extra points are awarded)

_________

Middle Initial Birth Year

Will this be secondary employment? Yes No

Available for employment which is? Full-time Part-time

Do you have a valid Driver’s license? Yes No

(For positions requiring a driver’s license, please attach a copy

of your license or write on a separate sheet of paper your driver’s license number, class, state of issuance and expiration date.)

STATE OF MARYLAND – AN EQUAL OPPORTUNITY EMPLOYER

Voluntary Equal Opportunity Information

To further its commitment to equal opportunity employment, the State of Maryland requests applicants to VOLUNTARILY

provide the following information. This information will be used for statistical purposes only by authorized personnel.

Birthdate: ___________________ Gender: Male Female

Citizenship: U.S. Citizen Legal Alien Other

Race: Are you Hispanic or Latino? Yes No

If you are not Hispanic or Latino, what is your race? Please select one .

Unknown/Decline to state

Decline to state

Asian

Origins in any of the original peoples of the Far East, Southeast Asia, or the India subcontinent, including for example,

Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

Black or African American

Origins in any of the black racial groups of Africa

American Indian or Alaska Native

Origins in any of the original peoples of North or South American, including Central America, and who maintains tribal affiliations

or community attachment.

Pacific Islander or native Hawaiian

Origins

in the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White

Origins in any of the original peoples of Europe, the Middle East, or North Africa

Veteran’s Information:

Do you seek veteran’s preference? Yes No

A copy (not original) of your proof eligibility DD-214 for Veterans Credit must be submitted and completely verified

before Veterans Credit will be approved. Proof will only need to be submitted once. Regular State employees do

not need to submit proof of eligibility for Veterans Credit. If Yes, you must also submit DD Form 214.

If you answered Yes to seeking veteran’s preference, select ONE of the following that best describes

your situation:

I am an honorably discharged veteran

I am a service-disabled veteran

I am a former prisoner of war (POW)

I am a Vietnam veteran

I am a service-disabled Vietnam veteran

I am the spouse of a deceased eligible veteran

I am the spouse of a service-disabled veteran

If you are a veteran, have you been honorably discharged?

Yes No

Are you fluent in a language other than English? (if required for the job for which you are applying)

Yes No If yes, please list: _____________________________________________

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Education and Training

Do you have a high school diploma or GED? Yes No If no, what is the highest grade you completed?

____

School: ____________________________ Address

(City, State):

_____________________________

Dates attended: _______ - _________ Major course of study: ______________________________

From To

College and Graduate School Education

Name/Location of School(s)

Dates Attended

Major

# of Credits

Completed

Type of Degree

Degree Earned?

(Yes or No)

Specialized Training or Classes Relevant to the Job

Title of Program/Course(s)

Company/School

Dates Attended

# of Credits

Earned

Diploma/Certificate

Received?

Please submit a copy of any relevant professional or trade licenses or certificates with this application.

Work Experience

Job Number 1: (Current or Most Recent)

Name of Employer: Employer’s Address (Street, City, State, Zip Code):

Type of Business: Supervisor’s Name, Title and Phone Number:

Your Job Title: Do you supervise other employees? Job Titles of Those You Supervise:

Yes No How many?

Dates of Employment (From: Month/Day/Year To: Month/Day/Year): Is your position considered full-time? Yes No

How many hours do you work per week?

Job Dutes:

Reason For Leaving:

List below, beginning with your most recent position, all of your work experience, including military service and all volunteer activities. Attach additional

8 1/2" x 11” sheets of paper if necessary. If your title and duties changed in the course of your service in any one organization, indicate such changes

clearly and as separate employment. Please do not submit a resume in lieu of completing this portion of the application. Be sure that the information

included in this section demonstrates that you meet the experience qualifications for the job for which you are applying.

STATE OF MARYLAND – AN EQUAL OPPORTUNITY EMPLOYER

Work Experience - Continued

Job Number 2:

Name of Employer: Employer’s Address (Street, City, State, Zip Code):

Type of Business: Supervisor’s Name, Title and Phone Number:

Your Job Title: Do you supervise other employees? Job Titles of Those You Supervise:

Yes No How many?

Dates of Employment (From: Month/Day/Year To: Month/Day/Year): Is your position considered full-time? Yes No

How many hours do you work per week?

Job Duties:

Reason For Leaving:

Job Number 3

Name of Employer: Employer’s Address (Street, City, State, Zip Code):

Type of Business: Supervisor’s Name, Title and Phone Number:

Your Job Title: Do you supervise other employees? Job Titles of Those You Supervise:

Yes No How many?

Dates of Employment (From: Month/Day/Year To: Month/Day/Year): Is your position considered full-time? Yes No

How many hours do you work per week?

Job Duties:

Reason For Leaving:

Job Number 4:

Name of Employer: Employer’s Address (Street, City, State, Zip Code):

Type of Business: Supervisor’s Name, Title and Phone Number:

Your Job Title: Do you supervise other employees? Job Titles of Those You Supervise:

Yes No How many?

Dates of Employment (From: Month/Day/Year To: Month/Day/Year): Is your position considered full-time? Yes No

How many hours do you work per week?

Job Duties:

Reason For Leaving:

STATE OF MARYLAND – AN EQUAL OPPORTUNITY EMPLOYER

Locations

In which counties will you accept employment?

Allegany

Anne Arundel

Baltimore City

Baltimore County

Calvert

Caroline

Carroll

Cecil

Charles

Dorchester

Frederick

Garrett

Harford

Howard

Kent

Montgomery

Prince George’s

Queen Anne’s

Somerset

St. Mary’s

Talbot

Washington

Wicomico

Worcester

YOU MAY BE TESTED FOR ILLEGAL DRUG USE. IF SELECTED FOR A POSITION IN THE SKILLED OR

PROFESSIONAL SERVICE, YOU MAY BE GIVEN A MEDICAL EXAMINATION TO DETERMINE YOUR ABILITY TO

PERFORM JOB-RELATED FUNCTIONS.

“UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT,

PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR

OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT

EXCEEDING $100.”

This provision does not apply to applicants for law enforcement positions pursuant to Labor and Employment Article,

Section 3-702 (b) Annotated Code of Maryland.

I hereby affirm that this application contains no willful misrepresentation or falsifications and

that this 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 misrepresentation or

falsification, my application will be disapproved, my name removed from the eligible list, and

that I will not be certified for employment in any position under the jurisdiction of the

Department of Budget & Management. I am aware that a false statement is punishable under

law by fine or imprisonment or both.

________________________ ____________________________________________________

DATE SIGNATURE OF APPLICANT