2. Hampton County
   Human Resources
   200 Jackson Ave. East
   Hampton, SC 29924
   Tel: (803) 914-2100
   Fax: (803) 914-2107
4. 
   
6. We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.
8. 
   
10. Position(s) Applied For:*
12. Date of Application:*
14. How Did You Learn About Us?*
    -- Select One --AdvertisementEmployment AgencyOur WebsiteFriendRelativeWalk-InOther:
18. 
    
20. PERSONAL INFORMATION
22. Last Name:*
23. First Name:*
25. Middle Initial:
27. Address (Number & Street)*
29. City*
30. State:*
31. Zip Code:*
33. Driver's License:*

    1. Yes
    2. No
35. Driver's License Number:*
36. State of Issue:*
38. Telephone Number:*
40. 
    
42. Please Answer The Following Questions
44. 
    
46. Have you ever filed an application with us before?*

    1. Yes
    2. No
48. Have you ever been employed with us before?*

    1. Yes
    2. No
50. Are you currently employed?*

    1. Yes
    2. No
52. May we contact your present employer?*

    1. Yes
    2. No
54. Are you prevented from lawfully becoming employed in this country because of a visa or immigration status? (Proof of citizenship or immigration status will be required upon employment).*

    1. Yes
    2. No
56. On what date would you be available for work?*
58. Are you available to work?*

    1. Full Time
    2. Part Tiime
    3. Shift Work
    4. Temporary
60. Are you currently on "lay-off" status and subject to recall?*

    1. Yes
    2. No
62. Can you travel if a job requires it?*

    1. Yes
    2. No
64. Have you been convicted of a crime other than a traffic violation? If Yes, please explain below).*

    1. Yes
    2. No
66. Please provide explanation of conviction(s)
68. 
    
70. EDUCATION
72. School Name and Location:*
74. Years Completed?*
    -- Select One --9101112
75. Diploma:*
    -- Select One --YesNo
77. Undergraduate College Name and Location:
79. Years Completed?
    -- Select One --1234
80. Degree:
82. Graduate/Professional Name and Location:
84. Years Completed?
    -- Select One --1234
86. Course of Study:
88. Describe any specialized training, apprenticeship, skills and extra-curricular activities including certifications and licensing.
90. Describe any honors you have received:
92. State any additional information you feel may be helpful to us in considering your application.
94. List professional, trade, business, or civic activities and offices held. (You may exclude memberships which would reveal sex, religion, national origin, age, ancestry, handicap, or other protected status).
96. 
    
98. REFERENCES
99. Give name, address and telephone numbers (home and work) of three references who are not related to you and are not previous employers.
101. First Name, Middle Initial, Last Name.*
103. Address: (Street Number and Name)*
105. City, State, and Zip Code:*
107. Telephone Number(s):
109. First Name, Middle Initial, Last Name:*
111. Address: (Street Number and Name)*
113. City, State, and Zip Code:*
115. Telephone Number(s):
117. First Name, Middle Initial, Last Name:*
119. Address: (Street Number and Name)*
121. City, State, and Zip Code:*
123. Telephone Number(s):
125. Have you ever had any job-related training in the United States Military?*

     1. Yes
     2. No
127. If Yes, please describe:
129. Would you have any difficulty performing any task related to this job?

     1. Yes
     2. No
131. If so, would you require reasonable accommodations?

     1. Yes
     2. No
133. 
     
135. EMPLOYMENT EXPERIENCE
136. Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap, or other protected status.
138. Employer Name, Address, Telephone Number:*
140. Job Title:*
141. Supervisor Name:*
143. Dates Employed:*
145. Hourly Rate/Salary:*
147. Reason for leaving:*
149. Responsibilities:*
151. Employer Name, Address, Telephone Number:*
153. Job Title:*
154. Supervisor Name:*
156. Dates Employed:*
158. Hourly Rate/Salary:*
160. Reason for leaving:*
162. Responsibilities:*
164. Employer Name, Address, Telephone Number:*
166. Job Title:*
167. Supervisor Name:*
169. Dates Employed:*
171. Hourly Rate/Salary:*
173. Reason for leaving:*
175. Responsibilities:*
177. 
     
179. APPLICANT'S STATEMENT
181. PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND TYPE YOUR NAME WHERE INDICATED. TYPING YOUR NAME SERVES AS OFFICIAL SIGNATURE OF APPLICANT IF SUBMITTING ONLINE. OTHERWISE PROVIDE APPLICANT SIGNATURE ON PRINTED APPLICATION.
183. I certify that all answers given herein are true and complete to the best of my knowledge.

     I hereby authorize Hampton County to conduct whatever investigation it deems necessary to confirm statements submitted on this application. If the investigation determines any untrue statements or answers, I accept this as sufficient reason for refusal to hire.

     I authorize and request each person, former employer, firm, or corporation, given as reference, to answer any and all questions related to my past work performance, character, or skill. I hereby release from liability, the employer and its representatives for seeking such information and all persons, corporations or organizations for furnishing such information.

     I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the employee may resign at any time and the employer may discharge employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by the County Administrator.

     In the event of employment, I understand that false or misleading information given on my application or during my interview(s), may result in dismissal. I also understand that I am required to abide by all rules and regulations of my employer.

     If employed, I agree, as a condition of my employment, that at such time or times during my employment as Hampton County shall require, will consent to and undergo testing for the presence of drugs and/or alcohol. I also agree that at the time of any such examinations, I will execute all forms of consent and release of liability as are usually and reasonable attendant to such examination. Finally, I agree that the results of any such examination shall be made available to Hampton County or its agents.
185. Signature of Applicant:*
187. Date:*
Leave This Blank:


189. 1. Receive an email copy of this form.
190. Email address

     This field is not part of the form submission.

191. Submit Submit and Print

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