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Applicants are considered for all positions without regard to race, religion, sex, national origin, age, marital status, or the presence of a non-job related medical illness or disability
Which position are you applying for?*
Which department are you applying for?
First Name*
Middle Name
Last Name*
Address1*
Address2
City*
State*
Zip*
Home Phone / Cell Phone*
Alternate Number / Cell Number
Email Address*
Have you ever filed an application with Meriwether County before?*
1. Yes
1. No
If yes give last date filed.
If yes give last date filed.
Have you ever been employed with Meriwether County?*
1. Yes
1. No
If yes give dates
If yes give dates Start Date
—
If yes give dates End Date
Are you currently employed?*
1. Yes
1. No
If yes, may we contact your present employer?
1. Yes
1. No
Do you have any relatives currently working with Meriwether County?*
1. Yes
1. No
If yes, please list name(s), relation, and department(s) below
Are you available for nights, weekends and on-call if required?*
1. Yes
1. No
Are you currently on lay-off subject to recall with another employer?*
1. Yes
1. No
Are you prevented from legally working in the United States due to Visa or Immigration Status*
1. Yes
1. No
Are you available to work:*
1. Full-time
2. Part-time
1. Seasonal
2. Temporary
Some work requires out of town training, can you travel?*
1. Yes
1. No
Are you 18 years of age or older?*
1. Yes
1. No
Do you have a valid Georgia Drivers License*
1. Yes
2. No
1. I have a valid out of state drivers license
Do you have a valid Georgia commercial drivers license?*
1. Yes
2. No
1. I have a valid out of state commercial drivers license
Have you read the job description for which you are applying?*
1. Yes
1. No
After reading the job description, are you able to perform the essential functions of this job with or without reasonable accomadations?*
1. Yes
1. No
If offered employment, on what date would you be available to report to work?*
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Education

Employment History and Past Experience.

EMPLOYMENT HISTORY - Please start with your current or most recent employer
EMPLOYER 1
Please fill in fields completely.
Name of Employer*
Dates Employed *
Dates Employed Start Date
—
Dates Employed End Date
Address
City*
State*
Phone*
Job Title*
Pay Rate at Start*
Pay Rate at Final*
Name of Supervisor*
Reason for Leaving?*
Please describe your job duties.*
EMPLOYER 2
Please fill in fields completely
Name of Employer*
Dates Employed *
Dates Employed Start Date
—
Dates Employed End Date
Address
City*
State*
Phone*
Job Title*
Pay Rate at Start*
Pay Rate at Final*
Name of Supervisor*
Reason for Leaving?*
Please describe your job duties.*
EMPLOYER 3
Note: If you have not had 3 employers in your work history, simply type "N/A" in the required fields.
Name of Employer*
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Address
City*
State*
Phone*
Job Title*
Pay Rate at Start*
Pay Rate at Final*
Name of Supervisor*
Reason for Leaving?*
Please describe your job duties.*
EMPLOYER 4
Note: If you have not had 4 employers in your work history, simply type "N/A" in the required fields.
Name of Employer*
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Address*
City*
State*
Phone*
Job Title*
Pay Rate at Start*
Pay Rate at Final*
Name of Supervisor*
Reason for Leaving?*
Please describe your job duties.*
SPECIAL SKILLS, CERTIFICATIONS, QUALIFICATIONS, SPECIALIZED TRAINING AND APPRENTICESHIPS
Please summarize any special skills, certifications, qualifications, special training or experience that you feel would be useful in helping us consider you for the position for which you are applying
MILITARY EXPERIENCE
Where you in the armed forces?
1. Yes
2. No
If yes, which branch?
Dates of duty:
Dates of duty: Start Date
—
Dates of duty: End Date
Rank at separation:
Type of Separation
1. Honorable
2. Dishonorable
3. Other
Please describe your duties
Please list any honors received:
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References

PERSONAL REFERENCES
Please provide information on three personal character references who are not related to you and are not previous employers
Personal Reference 1
Name*
Address
City
State
Zip Code
Best Phone Number*
Years Known?*
Occupation
How do you know this person?*
Personal Reference 2
Name*
Address
City
State
Zip Code
Best Phone Number*
Years Known?*
Occupation
How do you know this person?*
Personal Reference 3
Name*
Address
City
State
Zip Code
Best Phone Number*
Years Known?*
Occupation
How do you know this person?*
PROFESSIONAL REFERENCE
Please provide information on one professional reference who is not related to you, that you have worked with or for in the past
Professional Reference
Name*
Address
City
State
Zip Code
Best Phone Number*
Where did you work with or for this person?*
Occupation
How do you know this person?*
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Emergency Contact Info

EMERGENCY CONTACT
Please list information about the person you would like contacted in case of an emergency
Name*
Relationship to you*
Address
City
State
Zip Code
Phone Number*
Alternate Number
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Acknowledgment and Agreement

Please read the following in it's entirety
Authorization to Release Information / Conditions of Employment I have made application for employment with Meriwether County Government. I authorize any persons or organizations to give Meriwether County Government any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise with regard to any of the subjects covered by this application. I hereby release all such parties from all liability for any damage whatsoever for issuing same. Furthermore, if I am employed by Meriwether County Government, I agree to conform to the policies, rules, orders and regulations of the government set forth in the Meriwether County Government Personnel Policy and Ordinances; and acknowledge that these policies, rules, and regulations may be changed, interpreted, withdrawn, or added to by the Meriwether County Board of Commissioners at any time, at the Board of Commissioner's sole discretion. I further acknowledge that if I become employed with Meriwether County Government, my employment will be at-will and may be terminated with or without cause at any time by me or by Meriwether County until such time that I am no longer on my initial trial period, and become a regular status employee.
Alcohol and Controlled Substance Testing As a condition of employment with Meriwether County Government, I acknowledge I will be required to submit to and successfully pass an alcohol and controlled substance test prior to employment. Should I become an employee with Meriwether County Government, I understand that my position requires random controlled substance testing. I understand, as a condition of my employment, I must abide by all policies regarding the effects of drug use and the unlawful possession of controlled substances. I understand I will be expected to report for work without the effects of illegal drugs and alcohol in my system. I understand that I must report any conviction under a criminal drug statue for such violations. A report of the conviction must be made within five (5) days after the conviction.
Applicants Certification and Agreement I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I am aware that the falsification of this application or the omission of complete information will result in disqualification, or upon discovery, termination of my employment. Meriwether County Government is hereby authorized to make any investigation of my prior educational and work history. I agree that all records generated for purposes of employment are property of and shall remain the sole and exclusive property of Meriwether County Government and may be subject to disclosure under the Georgia Open Records Act. I acknowledge by signing this form to the conditions of employment, release of information, and consent to alcohol and controlled substance testing requirements.
Authorization of Criminal & Drivers History Release I hereby authorize Meriwether County Government or its designee to receive any Criminal History Record and Drivers History information pertaining to me which may be in the files of any state or local criminal justice agency, state drivers agency and files contained in FBI, NCIC, and GCIC databases and furthermore give consent to Meriwether County Government to perform periodic criminal and driver history background checks for the duration of my employment
Electronic Signature Acknowledgment*
1. I agree and acknowledge
By checking the "I agree" box above, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Applicant Signature*
Today's Date*
Today's Date

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