Taney County Employment Application

County of Taney, Missouri
Employment Application

Human Resources
132 David Street
PO Box 703
Forsyth, MO 65653
Please inform us if you require assistance in filling out an applicaton Ph: 417‐546‐7237
or taking a pre‐employment test. Individuals with disabilities Fax: 417‐546‐8900
should request reasonable accommodations in accordance with the
Americans with Disabilities Act prior to testing or appointment.

APPLICATION FOR EMPLOYMENT
Instructions to applicant: Please type or print legibly and complete all pages of this application. Please sign the
last page. Resumes and other materials may be attached.
Position(s) desired: 1) 2) 3)
Date Available: Employment desired: Full‐time ○ Part‐time ○ Temporary ○
Days/Hours Available for work:
PERSONAL INFORMATION
Name (Last, First, Middle) Social Security Number: Last 4 digits ONLY

Mailing Address (Street, City, County, State, Zip Code)

Home Phone #: Cell #: Email Address:
Are you legally permitted to work in the United States? Yes ○ No ○
(Proof of U.S. Citizenship or Immigration status will be required upon unemployment).
Do you have any relative(s) that work for Taney County? Yes ○ No ○
If yes, please list
Name Relationship Department

Have you ever been employed with Taney County before? Yes ○ No ○
Are you currently employed? Yes ○ No ○
Have you ever been known by another name(s)? Yes ○ No ○
If yes, please give name(s):
Have you ever pled guilty or "no contest" to, or been convicted of a serious misdemeanor or felony?
Yes ○ No ○
If yes, list complete conviction record on the back of this sheet ‐ use additional sheets, if necessary.
Please give full details, including dates, type of offense, location, etc.

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. In
answering these questions, do not include the following: (1) minor traffic infractions; (2) convictions for which the
record has been sealed or expunged.

Taney County is an Equal Employment Opportunity Employer and a Drug Free Facility which requires Drug and Alcohol Testing
EMPLOYMENTEXPERIENCE
In the space below list your com plete record o f em ploym ent for the past TEN years and any other relevant work/volunteer experience. Start
with your present or most recent position and list each position in the order that you held them. List any periods of unem ploym ent of one
month or more. If the vacancy announcem ent includes an experience requirement, be sure to show clearly that you meet such requirement. If
more space is need attach separate sheet(s) to this application.

Employer Dates of Employment
Start Date End Date

May we contact employer? Yes Q No Q Starting Salary Final Salary
Address

Phone Number Reason for leaving

Your Job Title Supervisor's Name and Title
Description of Duties
Employer Dates of Employment
Start Date End Date

May we contact employer? Yes Q No Q Starting Salary Final Salary
Address

Phone Number Reason for leaving

Your Job Title Supervisor's Name and Title
Description of Duties
Employer Dates of Employment
Start Date End Date

May we contact employer? Yes Q No Q Starting Salary Final Salary
Address

Phone Number Reason for leaving

Your Job Title Supervisor's Name and Title
Description of Duties
Employer Dates of Employment
Start Date End Date

May we contact employer? Yes Q No Q Starting Salary Final Salary
Address

Phone Number Reason for leaving

Your Job Title Supervisor's Name and Title
Description of Duties

Taney County is an Equal Employment Opportunity Employer
and a Drug Free Facility which requires Drug and Alcohol Testing
EDUCATION AND TRAINING
Please complete all appropriate items. To receive credit for college education, you must submit a copy
of your transcript(s).
Type of School Name and location of school Degree and/or Credit Hours Majors/Minors

High School
Did you graduate or obtain equivalency diploma (GED)? Yes O No O
Vocational School

College or University

Graduate School

Other Training (Explain)

PROFESSIONAL INFORMATION (if applicable)
Please list any professional, paraprofessional, or technical certificates or licenses that you currently hold
(include peace officer certification, motor vehicle operator license, CDL etc. , if it is a requirement of the
position for which you have applied.)

License or Certification Held: Licensing State and/or Agency:

LAW ENFORCEMENT APPLICANTS ONLY_______________________________________________
Are you a United States citizen? Yes O No O
Please attach the following information, which is a requirement for Missouri POST Certification:
Proof of U.S. Citizenship
Missouri Peace Officer Certification
_________ A copy of your High School Diploma, GED or college diploma or transcript___________
List below any information concerning military duty, if any:
Branch of Service:__________________ Type of Discharge:_________________ Dates of Service:

ROAD AND BRIDGE APPLICANTS ONLY
Do you have a CDL License? Yes O No O
Please attach the following information:
A copy of your CDL License

ADDITIONAL QUALIFICATIONS____________________________________________________________
Please list any other knowledge, special technical or computer skills, and/or individual capabilities not
previously listed that would especially prepare you for the position for which you have applied?_____

Taney County is an Equal Employment Opportunity Employer
and a Drug Free Facility which requires Drug and Alcohol Testing
PERSONAL REFERENCES
Please list the names of three persons who are not related to you and not previously listed as a current or former
supervisor that we may contact for a personal reference.
Name Phone Email Address Years Known

CERTIFICATION OF APPLICANT AND AUTHORIZATION FOR RELEASE OF INFORMATION
Please read the statements below carefully . Your signature indicates that you fully understand and agree to the
provisions of each statement.
Name: Social Security Number: Last 4 digits ONLY

I certify that all statements made by me on this application are true and complete to the best of my knowledge. I understand that any false
or inaccurate information could result in disqualification of this application and/or termination of employment if I have been employed.

I understand and agree that employment with Taney County is voluntarily entered into, and employees are free to resign at will at any time,
for any reason, with or withot cause or notice. I further understand and agree that the County or any elected official thereof, may terminate
the employment relationship at will at any time for any reason, with or without cause or notice. This is not a contract for employment.

It is further understood and agreed that should my employment with Taney County be terminated for any reason, my final pay will not be
received until I have submitted all necessary paperwork and returned any and all property assigned to me during the course of my
employment, including but not limited to all keys, uniforms, equipment, and County‐issued identification.

In consideration of my employment, I agree to conform to the policies, procedures, and regulations of Taney County.

I, the undersigned, do hereby authorize Taney County to conduct an investigation in respect to my application and release the County, my
former employers, and personal references from any liability for damage caused by giving and receiving information or opinions as to my
employment or character. Any information obtained through former employers and/or personal references will become the property of
Taney County.

I, the undersigned, do hereby authorize the release of any information which pertains to records of convictions for law violations, including
felony, misdemeanor and traffic violations, and agree to hold Taney County harmless and in no event shall Taney County be liable to me for
special, indirect or consequential damages for the refusal of employment due to information obtained during my police record check.

I further understand that any offer of employment is conditioned upon the results of reference checks, drug testing, and if a requirement of
the position, police record checks, background checks, and post‐offer physical exams.

Applicant Signature:_________________________________________________ Date: _________________________________

Taney County is an Equal Employment Opportunity Employer and a Drug Free Facility which requires Drug and Alcohol Testing