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(Last, First, Middle Initial)
(Include City, State, Zip)
List your educational history below.
List your work history below, going back at least ten (10) years, beginning with your current or most recent job.
You must provide current contact information for all employers or supervisors.
Describe the types of computer equipment and software programs you have used and your level of experience with each.
List any specialized training, apprenticeship, skills, extracurricular activities, and additional schooling or educational awards you may have.
Summarize any other experience, volunteer work, or any related general information; including any licenses or technical skills;
professional, trade, business, or civic activities and offices you have held.
Use this section to provide any additional information that you feel is applicable in answering the questions asked in this application that require detailed answers. List the corresponding page name (i.e. References). Should you need additional space, please upload the documents below.
Please upload documents
I certify that answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment as may be necessary for
arriving at an employment decision. I also consent to a background investigation and reference check.
This application for employment shall be active for some time, not to exceed 45 days.
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 the 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 an authorized executive of the organization.
In the event of employment, I understand that false or misleading information given in my application or
interview(s) may result in discharge at any time. I understand, also, that I am required to abide by all rules and
regulations of the employer.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
The Equal Employment Opportunity Commission (EEOC) requires organizations with 100 or more employees
to invite applicants to self-identify gender and race. The purpose is to ensure equal employment opportunity
and evaluate our good-faith recruiting efforts to attract ethnic minorities, women, veterans, and persons with
disabilities. Blaine County conducts its hiring based on applicant qualifications. Quotas or preferences based on
gender, race, or ethnicity are prohibited by law.
Completion of this data is VOLUNTARY and will not affect your opportunity for employment, or terms or
conditions of employment. We invite you to VOLUNTARILY identify yourself in the categories below - now or
at any time in the future. This is NOT part of your application file; it is confidential and will be used in
conformance with the law. Please complete this form and return to Blaine County Human Resources.
This field is not part of the form submission.
* indicates a required field