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 application or taking a pre-employment test. Individuals with
disabilities should request reasonable accommodations in accordance with the Americans with Disabilities Act prior to Phone: 417-546-7237
testing or appointment. Fax: 417-546-8900

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.
Departments Interested In:
911 Administration Coroner Prosecutor
Admin Services County Clerk Public Admin
Airport Emergency Management Recorder
Assessor Human Resources Road & Bridge
Auditor Information Technology Sheriff Department
Building & Grounds Juvenile Treasurer
Collector Planning & Zoning University Extension

Type of Position Interested In (Clerical, IT, Equipment Operator, etc)

Date Available: Employment Desired:
Full-Time Part-Time Temporary
Days/ Hours Available for Work:

PERSONAL INFORMATION:
Name (Last, First, Middle) SSN (last 4 digits only)

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

Home #: Cell #: Email Address:
Are you legally permitted to work in the United States? (Proof of U.S. Citizenship or Yes No
Immigration status will be required upon employment.)
Are you currently employed? Yes No
Have you ever been employed with Taney County before? Yes No
Have you ever been known by another name(s)? If yes, please give names: Yes No

Do you have any relative(s) that work for Taney County? If yes, please list: Yes No
Name Relationship Department

Have you ever pled guilty or “no contest” to, or been convicted of, a serious misdemeanor or Yes No
felony? If yes, list complete conviction record.

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 rehabilitationwill be taken into account. In answering these questions, do not
include the following: (1) minor traffic infractions; (2) convictions forwhich 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.
EMPLOYMENT EXPERIENCE
In the space below list your complete record of employment 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 unemployment of one month or more. If the
vacancy announcement includes an experience requirement, be sure to show clearly that you meet such requirements. If more space is need attach
separate sheet(s) to thisapplication.
Employer Dates Of Employment
Start Date: End Date:

Starting Salary: Final Salary:
May we contact employer? Yes No
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:

Starting Salary: Final Salary:
May we contact employer? Yes No
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:

Yes No Starting Salary: Final Salary:
May we contact employer?
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:

Starting Salary: Final Salary:
May we contact employer? Yes No
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.
Type of School Name and Location of School Degree and/ or Credit Majors/ Minors
Hours

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

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 No
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 No
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:

CERTIFICATIONOF 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 thisapplication 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: -------------

SUBMIT RESET

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