PERRY COUNTY TRANSIT · 740-342-2810

Job Application

Date of Application

Position

Personal Information

Full Name

Address

City

State/Province

Zip/Postal Code

Country

Phone Number

Email Address

Educational Background

Education history: course or degree, institute or university, year of graduation, grade and city
Course / Degree	Institute / University	Year of Graduation	Grade	City
Row 1 course or degree	Row 1 institute or university	Row 1 year of graduation	Row 1 grade	Row 1 city
Row 2 course or degree	Row 2 institute or university	Row 2 year of graduation	Row 2 grade	Row 2 city
Row 3 course or degree	Row 3 institute or university	Row 3 year of graduation	Row 3 grade	Row 3 city

Employment History

Most recent employer

Employer

Job Title

Phone Number

Supervisor

Start Date

End Date

Responsibilities

Why I Quit

Previous employer

Employer

Job Title

Phone Number

Address

Start Date

End Date

Responsibilities

Why I Quit

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Skills & Training

Office Skills

Computer Skills

Other Skills

Specialized Skills

Additional Certificates

Questions

1. Please indicate your county of residence.

2. Summary of Qualifications — briefly describe the experience, education and training that qualify you for this position.

3. Please list below any specific course work relevant to this position.

4. Have you ever been convicted of a felony? (A felony may not automatically exclude you from consideration.)

Yes No

5. If you answered Yes to the previous question, please give date(s) and explain.

6. If previously employed in a safety sensitive position, did you fail, test positive or refuse a DOT drug and alcohol test in the last 24 months?

Yes No Not Applicable

7. If you answered Yes to the previous question, please give date(s) and explain.

8. How did you learn about this employment opportunity?

I confirm that my responses are honest and complete, understanding that providing inaccurate information may lead to termination if employed.

Signature

Date

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