Recruitment Form

This form is intended to help the responsible of a recruitment interview.

Application information

Last Name *

First Name *

M.I. *

Street Address *

Apartment/Unit # *

City *

State *

Zip *

Phone (numbers only) *

Email Address *

Date Available

Social Security No (numbers only)

Desired Salary

Positional Applied for

Are you a citizen of the United States?

If no, are you authorized to work in the U.S.?

Have you ever worked for SCDC before?

If so, when?

Have you ever been convicted of a felony?

If Yes, explain

Education and Activities

Skills and Knowledge (please list out)

High School

High School Address

From

To

Did you graduate?

College

College Address

From

To

Did you graduate?

Other Schooling

Address(es)

From

To

Experience

Activities

References

Reference 1 - Full Name

Relationship

Company

Phone

Address

Reference 2 - Full Name

Relationship

Company

Phone

Address

Reference 3 - Full Name

Relationship

Company

Phone

Address

Previous Employment

Company 1

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

To

Worked from

Reason for Leaving

May we contact your previous supervisor for reference?

Company 2

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

To

Work From

Reason for Leaving

May we contact your previous supervisor for a reference?

Company 3

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Date From

To

Reason for leaving

May we contact your previous supervisor for a reference?

Military Service

Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain