Fillable Printable PDF File of State Application
Fillable Printable PDF File of State Application
PDF File of State Application
STATE OF SOUTH CAROLINA
EMPLOYMENT APPLICATION
THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE EMPLOYEE AND THE
AGENCY. THIS DOCUMENT DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS. THE AGENCY RESERVES THE RIGHT
TO REVISE THE CONTENT OF THIS DOCUMENT, I N WHOLE OR IN PART. NO P RO MISES OR ASSURANCES, WHETH ER WRITTE N O R O RAL,
WHICH ARE CO NTRARY T O OR INCONSISTENT WIT H THE TERM S O F THIS PARAGRAPH CREATE ANY CONTRACT OF EMPLOYMENT.
P osition applying for:
Job Title ____________________________________________________________________________________________________________________________
Agency __________________________________________________________________________________________ Location ___________________________
Contact Information
Name ___________________________________________________________________________________ Fo rm er Last Name ____________________________
First Middle Initial Last
Mailing Address ______________________________________________________________________________________________________________________
Address ____________________________________________________________________________________________________________________________
City County State Zip Cod e
Email Address _______________________________________________________________________________________________________________________
Home Phon e_________________________________ Alternate Phone _______________________________ Notification Pref erenc e Mail Email
Other Personal Information
Do you pos sess a valid dri ver’ s lic ense? Yes No If yes, provide State and number: _____________________________________________________________
Ex pir a tion date __________________ Clas s (check o ne) A B C D E F M G
Can you, after emp loyment, sub m it proof of your legal right to work in th e Unit ed Sta tes? Yes No ______________________________________
Month an d Day of Birth
Are you willing to r eloc at e? Yes No If yes, provide counties _____________________________________________________________________
What type of job are you looking for? Regular Temporary Seasonal Internship
What types of work will you accept? Full Time Part Time Per Diem
What sh ifts ar e you available to work? Day Evening Night Rotating Weekends On Call (as needed)
Education
High School Name _____________________________________ Location _____________________________ Diploma Other (specify) ______________
Give name and address of school, m aj o r course o f study, and d eg ree a chieved.
Undergraduate College/University ____________________________________ Graduate School ___________________________________________________
Degr ee At t ai n ed __________________________________________________ Degr ee At t ai n ed ____________________________________________________
Year ___________________________________________________________ Year _____________________________________________________________
Additional Information
Certi fica tes and Licenses ________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Addi tional Skills ______________________________________________________________________________________________________________________
The State of South Carolina - an Equal Opportunity E mployer
STATE OF SOUTH CAROLINA
EMPLOYMENT APPLICATION
Please carefully read the following information:
In addition to evaluating you for the position for which you are applying, the following questions will provide us with statistics needed to evaluate our recruitment
program, as well as to prepare statistical rep orts required by Federal, State and local agencies.
Have you ever been c o nv icted of a c riminal o ffens e? Yes No
Note: Omit minor vehicle violations and any offense committed before your 17
th
birth day, w hich wa s fin ally a djudic ated i n juve nile c ourt or u nder a yout hful o ffende r
la w. Con victi o n of a cri m inal offe ns e i s not a bar t o em plo ym ent i n all c as es. Each conviction is evaluated individually.
If y es, pl ease list charg e(s) _________________________________________________________________________________________________________
Where Conv icted____________________________________________________ Date _____________ Disposition/Status ____________________________
Are you currently employed by the State of South Carolina? Yes No I f ye s , w hich age ncy?_________________________________________________
Do you have any relatives employed with the State of South Carolina? Yes No If yes, pl eas e provide name(s) , r elationship, and agency bel ow.
Name _____________________________________ Relationship ______________________ Agency _____________________________________________
Name _____________________________________ Relationship ______________________ Agency _____________________________________________
Have you ever been term inated or forced to resign from any job? Yes No If y es, pl ease explain below.
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Will yo u need rea sonable accommodations to par t icipate in the selection pr o cedur es (e.g., inter view, w ri tten tests, or job demonstration)? Yes No
If yes, contact the human resources offi ce of the agency for which you are applying.
State agencies are actively supporting the Family Independence Act by hiring welfare and food stamp recipients for certain jobs. Are you currently receiving AFDC
b enefit s or food st amps ? Yes No
Gender: Female Male Date of birth : ______ / _______ /________ Social security number: _______ - ______ - ______
Ethnicity: American Indian / Alaska Native Asian Black / African American Hispanic / Latino
Native Hawaiian / Other Pacific Islander Two or More Rac es White
Student Loan: State La w (59-111-50) prohibits employment with the State to people who have defaulted on certain student loans, unless they can prove that satisfactory
arrangem ents have been ma de for r ep ayment. By my sig natur e, I certify that I am not currently in default on a student loan.
Have you been separated f r o m Sou th Car o lina Sta te Government empl o yment as a p art o f a reduction-in-fo r ce wit hi n the pas t 12 mo n t hs? Yes No
Signature _____________________________________________________ Date ______________________________
Authority to Release Information: By my signature, I consent to the release of information to authori zed of fic ers, a gent s, and emp loyees of t he St at e of Sou th C aroli na
which may include but not be limited to information concerning my past and present work; including my official personnel files; attendance records; evaluations;
educational records including transcripts; military service; law enforcement records; and any personnel record deemed necessary. In addition, I consent to authorize
appropriate officers, agents and employees of the State to make inquiries of third parties. I further release the organization, educational entity, present and former
employers, law enforcement organization, all third parties from any and all claims of whatever nature that I may have as a result of any inquiry or response given to
such inquiries made in connection with my application for employment.
Signature _____________________________________________________ Date ______________________________
Certification of Applicant: By my signature, I affirm, agree, and understand that all statements on this form are true and acc urat e. An y mis repr esentation, falsification,
or material omission of information or data on this application may result in exclusion from further consideration or, if hired, termination of employment. If I have
requested herein that my present employer not be contacted, an offer of employment may be conditioned upon acceptable information and verification from such
employer pri or to beginning work.
Signature _____________________________________________________ Date ______________________________
Give the name, address, and phone number of two people, not relatives, who are familiar with your work.
Name ___________________________________________ Address __________________________________________________ Phone ____________________
Name ___________________________________________ Address __________________________________________________ Phone ____________________
STATE OF SOUTH CAROLINA
EMPLOYMENT APPLICATION
Work History
Describe your work experience in detail, beginning with your current or most recent job. Include military service (indicate rank) and job related volunteer work, if
applicable. Provide explanation for any gaps in employment. All information in this section must be complete. A résumé may be attached, but not substituted for
complet ing this section. Sh ould you need add iti onal space, copy this pa ge.
1. Name of Pres ent o r Last Employer: _____________________________________________________________________________________________________
Job Title: ___________________________________________________________________________________________________________________________
Address: _______________________________________________________________ Phone ____________________ Supervisor _________________________
From: ______ / _______ / ______ To: ______ / ______ / ______ Hour s Per Week ________ Salary ______________ Number Supervised ______
M ay we c o ntact this em pl oy er? Yes No
Job Duties (give details) ________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Rea son For Leaving ___________________________________________________________________________________________________________________
2. You r Next Most Recent Employer: _____________________________________________________________________________________________________
Job Title: ___________________________________________________________________________________________________________________________
Address: _______________________________________________________________ Phone ____________________ Supervisor _________________________
From: ______ / _______ / ______ To: ______ / ______ / ______ Hour s Per Week ________ Salary ______________ Nu mber S u pervis ed ______
May we contact this employ er? Yes No
Job Duties (give details) ________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Rea son For Leaving ___________________________________________________________________________________________________________________
3. You r Next Most Recent Employer: _____________________________________________________________________________________________________
Job Title: ___________________________________________________________________________________________________________________________
Address: _______________________________________________________________ Phone ____________________ Supervisor _________________________
From: ______ / _______ / ______ To: ______ / ______ / ______ Hour s Per Week ________ Salary ______________ Nu mber S u pervis ed ______
May we contact this employer? Yes No
Job Duties (give details) ________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Rea son For Leaving ___________________________________________________________________________________________________________________
