Taney County Road & Bridge Employment Application

TANEY COUNTY ROAD & BRIDGE DEPARTMENT
APPLICATION FOR EMPLOYMENT
This application must be filled in completely or it will not be processed. If a box does not apply to you , indicated with N/A in that space.

We are an equal opportunity employer whose policy it is to select the most qualified candidates without regard to race,
religion, color, sex, age, marital or military status, history of disability or national origin.

Position Desired: -- - - - - - -- - -- - -- - [ ] Part time [ ] Full time Salary Desired: - - - - - - - --

Do you hold a Missouri COL: YES [ ] NO [ ]

Name : _~-----~~-----=--------------~--- Date:
Last (Print) First Middle
Present How long have
Address: - -- - - -- - - -- - - -- - - -- - - - you lived there?
Street and Number City State Years Months
Previous How long did
Address: --::----~,--,--------=------........,--­ you live there?
Street and Number City State Years Months

Telephone No.:-- - -- - - - -- - - -- - -- - - Social Security No.:

In case of emergency, notify: - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -
Address:_ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ Phone: - - - - - - - - -

Have you ever worked for Taney County before? [ ] Yes [ ] No

Are you related to anyone that is currently employed with Taney County? [ ] Yes [ ] No

If Yes, please list the employee:---- - - - - - -- - - -- - - - - -- - - - - -- - -- -- -

Have you ever pled guilty, or no contest to, or been convicted of any misdemeanor or felony? [ ] Yes [ ] No

If Yes, please identify the type of crime(s), date(s) of conviction and penalties imposed: - -- -- - -- - - -- - - - - -

Have you been arrested for any matters for which you are out on bail or on your own recognizance pending trial? [ ] Yes [ ] No

If Yes, please give the date(s) and details: -- - -- - - - -- - -- - - -- - -- - - - - - - - - - - - -

NOTE: Answering "Yes" to these questions does not constitute an automatic bar to employment. Factors such as age and time of the
offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (Do not include minor traffic citations
and arrests or convictions that have been sealed or expunged in answering this question.)

RECORD OF PREVIOUS EMPLOYMENT
Please list the names of your present or previous employers in chronological order with present or last employer listed first. Be sure to account
for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business
references.lAdd additional paQe if necessary]
Present or Last Employer Employed Pay Your Title or Position Exact Reason for Leaving
From (mo/yr) Start
Address $

City, State, Zip Code To (mo/yr)
Final Name and Title of
Telephone $ Last Supervisor
 Previous Employer Employed rn Your Title or Position Exact Reason for Leaving
From (mo/yr) Start
Address $

City, State, Zip Code To (mo/yr)
Final Name and Title of
Telephone $ Last Supervisor

Previous Employer Employed Pay Your Title or Position Exact Reason for Leaving
From (mo/yr) Start
Address $

City, State, Zip Code To (mo/yr)
Final Name and Title of
Telephone $ Last Supervisor

Previous Employer Employed Pay Your Title or Position Exact Reason for Leaving
From (mo/yr) Start
Address $

City, State, Zip Code To (mo/yr)
Final Name and Title of
Telephone $ Last Supervisor

Have you ever been terminated or asked to resign from any job? [ ) Yes [ ) No

Please explain fully any gaps in your employment history: _-- - - - - - - - -- - - - - - -- - -- - - - -- - -

May we contact your current employer? [ ] Yes [ ] No

If No, please explain: - - - - - - -- - -- - - - - - - - - - - - - - - - - - -- -- - -- - - -- - -

Please indicate any actual experience, special training and qualifications that you have which you feel are relevant to the position for which you
are applying: - -- - - - - - - - - - - - - - - - - - - - - - - - - - - -- -- - -- - -- - - -

If hired, can you furnish proof that you are over 21 years of age? [ ] Yes [ ] No

Are you authorized to work in the United States? [ ] Yes [ ] No

Are you capable of satisfactorily performing the essential job duties required of the position for which you are applying? [ ] Yes [ ] No

Do you have adequate transportation to and from work? [ ] Yes [ ] No

EDUCATION
School Name Years Diploma/Degree Describe Course of Describe Specialized
Completed Study or Major Training, Experience, Skills and Extra-
(Circle) Curricular Activities

Elementary: 4 5 6 7 8

High School: 9 10 11 12
 College/University: 1 2 3 4

Graduate/Professional: 1 2 3 4

Trade or
Correspondence:

PERSONAL REFERENCES

Please list persons who know you well -- not previous employers or relatives
Name Occupation Address Telephone Number of Years Known
(Street, City and State) Number

THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF ONE YEAR. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER
THAT TIME, YOU MUST REAPPLY.

If hired, I understand the following : My employment and compensation is terminable at-will, is for no definite period, and my
employment and compensation may be terminated by the County at any time and for any reason whatsoever, with or without good
cause at the option of the Taney County Commission and/or the Road Administrator. No implied, oral, or written agreements
contrary to the principles of employment at will unless any such agreement is in writing and signed by the Taney County
Commission. No supervisor or representative of the County has any authority to make any agreements contrary to this paragraph
and which in any way might serve to abrogate any employee's at-will status. This application and the language contained herein do
not constitute an agreement, and Taney County retains the right to terminate with or without good cause.

I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE.

Date Signature of Applicant