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 ANDTHE
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____________________________
FirstMiddle InitialLast
Mailing Address______________________________________________________________________________________________________________________
Address____________________________________________________________________________________________________________________________
CityCountyStateZip 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 andnumber:_____________________________________________________________
Ex pir a tion date__________________Clas s (check o ne) AB C D EF 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 Dayof Birth
Areyou willing to r eloc at e? Yes NoIf yes, provide counties_____________________________________________________________________
What type of job are you looking for? Regular Temporary Seasonal Internship
Whattypes of work will you accept? Full Time Part Time Per Diem
What sh ifts ar e you available towork? Day Evening Night Rotating Weekends On Call (as needed)
Education
High School Name_____________________________________Location_____________________________DiplomaOther (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 allc 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 NoI f ye s , w hich age ncy?_________________________________________________
Do you have any relatives employed with the State of South Carolina? Yes NoIf 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 NoIf 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
Ifyes, 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: FemaleMaleDate of birth : ______/_______/________Social security number:_______- ______- ______
Ethnicity:American Indian / Alaska Native Asian Black / African AmericanHispanic / Latino
Native Hawaiian / Other Pacific Islander Two or More Rac es White
Student Loan: StateLa 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 mysignature, I consent to the release of information to authori zed of fic ers, a gent s, andemp loyees of t he St at e of Sou thC aroli na
which may include but not be limited to information concerning my past and present work; including myofficial personnel files;attendance records; evaluations;
educational records including transcripts; military service;law enforcement records; andany personnelrecord deemed necessary. In addition, I consent to authorize
appropriate officers, agents andemployees 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 ofwhatever 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 ofemployment 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 (indicaterank) 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?YesNo
Job Duties (give details)________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Rea son For Leaving___________________________________________________________________________________________________________________
2. You r Next Most RecentEmployer: _____________________________________________________________________________________________________
Job Title: ___________________________________________________________________________________________________________________________
Address:_______________________________________________________________Phone____________________Supervisor_________________________
From:______/ _______/ ______To:______ / ______/ ______Hour s Per Week________Salary______________Nu mber S u pervis ed______
May wecontact this employ er?YesNo
Job Duties (give details)________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Rea son For Leaving___________________________________________________________________________________________________________________
3. You r Next Most RecentEmployer: _____________________________________________________________________________________________________
Job Title: ___________________________________________________________________________________________________________________________
Address:_______________________________________________________________Phone____________________Supervisor_________________________
From:______/ _______/ ______To:______ / ______/ ______Hour s Per Week________Salary______________Nu mber S u pervis ed______
May we contact thisemployer?YesNo
Job Duties (give details)________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Rea son For Leaving___________________________________________________________________________________________________________________
