STATE VACANCY ANNOUNCEMENT - Housekeeping Supervisor, Marietta, GA
STATE VACANCY ANNOUNCEMENT - Housekeeping Supervisor, Marietta, GA  - Download as a PDF or view online for free
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1. STATE OF GEORGIA APPLICATION FOR EMPLOYMENT Georgia Department of Defense version An Equal Opportunity Em ployer and Drug-Free W ork place ANNOUNCEMENT JOB TITLE ANNOUNCEMENT NUMBER PERSONAL INFORMATION: Last Name First Name Middle Initials Street or Mailing Address Apartment No. City State Zip Code County Contact Phone Numbers (s) Email address Cell: Home: EMPLOYMENT ELIGIBILITY: To be employed by the State of Georgia and the Georgia Department of Defense, you must meet certain State and Federal employment eligibility requirements. These include (but are not limited to) United States citizenship or authorization to work in this country, positive rehire status if previously employed by the State, and no felony convictions (for some jobs). Please answer the following questions. 1. Are you a United States citizen? 2. Are you an alien authorized to work in 3. Have you ever been dismissed from any 4. Have you ever been convicted the United States? State of Georgia government position? of a felony? YES NO N/A YES NO YES NO YES NO If YES, attach an explanation. If YES, attach an explanation. EDUCATION: High School Graduate or Vocational/Business School: No. of Field of Study: Completed: Yes No Equivalent (GED)? Months: Date: Yes No (Mo/Yr) TYPE OF DATE CREDIT PLEASE LIST EXACT COLLEGE HOURS : DEGREE DEGREE RECEIVED FIELD/AREA OF CONCENTRATION COMPLETED COLLEGES/UNIVERSITIES CITY and STATE DATES Qtr Sem (BA/BS/ Hrs Hrs Major Hrs Minor Hrs MA/PhD) (Mo./Yr.) ATTENDED OTHER LANGUAGES SPOKEN: Sign Language Type of License/Certificate License/Certificate Expiration Specialization/ Number (Mo./Yr.) Endorsements Current Valid Commercial Driver’s License (CDL): Class (Check One): A B C Teacher Certified in Georgia: Type of Certificate Held: Other Professional License/Certificate: CERTIFICATION: Read carefully before signing and dating. Incomplete and/or unsigned applications will not be processed. I certify that all information on this application is correct. I authorize any agent or employee of the State to verify this information and to release it to anyone who may consider me for appointment. I understand that intentionally providing false information on this form or attachments is a violation of state law. I also understand that applications submitted electronically, via e-mail or similar media, are not valid unless I enter my name in the signature field below and such action shall constitute an electronic signature. I further certify that either: 1) I have not been convicted of a drug-related criminal offense; or 2) if I have been convicted of a drug-related criminal offense, it has been more than three (3) months since my first conviction, or more than five (5) years since a second or subsequent conviction (O.C.G.A. 45-23 et. Seq.). Signature: Date: GA DOD State Personnel Office Page 1 August 2011 version

2. Applicant Name: WORK HISTORY – ALL RELEVANT EXPERIENCE AND COMPLETE WORK HISTORY FOR THE PAST TEN YEARS: Complete ALL fields. Include military and volunteer experience; explain any GAPS in employment. If you worked for the same employer but held different jobs, describe each separately. Describe in detail the specific duties beginning with your primary duties. If you need more space, print additional work history page(s) and attach to the application. Include additional documents as requested, such as the DD214 member 4 copy. A resume may be attached but will not substitute for a completed application. FAILURE TO GIVE COMPLETE AND DETAILED INFORMATION REGARDING EACH JOB HELD MAY RESULT IN YOUR DISQUALIFICATION FROM EMPLOYMENT CONSIDERATION. Current or Last Employer: Your Job Title: Address From (mo/yr) To (mo/yr) Hours per Week: City State Zip Code Check all that apply: Annual Salary Volunteer Intern Paid Your Supervisor’s Name and Title May We Contact Employer? Your Supervisor’s Phone Number YES NO ( ) Reason for Leaving # and types of employees you supervised: Describe in detail your job duties. (Attach additional pages or continue on back if necessary.) Employer: Your Job Title: Address From (mo/yr) To (mo/yr) Hours per Week: City State Zip Code Check all that apply: Annual Salary Volunteer Intern Paid Your Supervisor’s Name and Title May We Contact Employer? Your Supervisor’s Phone Number YES NO ( ) Reason for Leaving # and types of employees you supervised: Describe in detail your job duties. (Attach additional pages or continue on back if necessary.) Employer: Your Job Title: Address From (mo/yr) To (mo/yr) Hours per Week: City State Zip Code Check all that apply: Annual Salary Volunteer Intern Paid Your Supervisor’s Name and Title May We Contact Employer? Your Supervisor’s Phone Number YES NO ( ) Reason for Leaving # and types of employees you supervised: Describe in detail your job duties. (Attach additional pages or continue on back if necessary.) GADOD State Personnel Office Page 2 August 2011 version

3. Applicant Name: CONTINUED WORK HISTORY Employer: Your Job Title: Address From (mo/yr) To (mo/yr) Hours per Week: City State Zip Code Check all that apply: Annual Salary Volunteer Intern Paid Your Supervisor’s Name and Title May We Contact Employer? Your Supervisor’s Phone Number YES NO ( ) Reason for Leaving # and types of employees you supervised: Describe in detail your job duties. (Attach additional pages or continue on back if necessary.) Employer: Your Job Title: Address From (mo/yr) To (mo/yr) Hours per Week: City State Zip Code Check all that apply: Annual Salary Volunteer Intern Paid Your Supervisor’s Name and Title May We Contact Employer? Your Supervisor’s Phone Number YES NO ( ) Reason for Leaving # and types of employees you supervised: Describe in detail your job duties. (Attach additional pages or continue on back if necessary.) *** Attach additional w ork history pages if needed *** MILITARY SERVICE NOT LISTED ABOVE: Have you ever served in the United States Military? Yes (please com plete below ) No (skip this section ) Branch From To Type of Discharge (MM/DD/YYYY) (MM/DD/YYYY) ** if not honorable – please explain GADOD State Personnel Office Page 3 August 2011 version