PORT ROYAL POLCE DEPARTMENT P.O. BOX 576 PORT ROYAL, SC 29935 843 9862220 FAX 843 9862226 Web : www.portroyal.org APPLCATON FOR EMPLOYMENT POSTON APPLYNG FOR: PERSONAL DATA Social Security Number City, State, Zip Home Telephone Driver's License # and State Business Telephone CDL # and Class son to contact in case of an emergency Relationship City, State, Zip Telephone EDUCATONAL DATA EDUCATON NAME AND LOCATON NUMBER OF YEARS COMPLETED DD YOU GRADUATE? DPLOMA OR DEGREE MAJOR OR COURSE OF STUDY High School Business/Tra College Graduate School Other SPECAL SKLLS List any special skills or qualifications you have including certifications, licenses, etc.. FOR OFFCAL USE ONLY TEST Type of Test Results/Score Date NTERVEW NOTFCATON Time Comments P
Each question must be answered completely. List work history including, parttime, temporary, selfemployment and military service beginning with your present or most recent position. Entry Salary $ 1 Ending Salary S 2 3 Entry Salary $ per
Each question must be answered completely. List work history including, parttime, temporary, selfemployment and military service beginning with your present or most recent position. Entry Salary $ 4 Entry Salary S 5 YT Entry Salary $ 6
Have you ever been employed by Town of Port Royal? Yes What Year? ~ Are you related to anyone presently employed by Port Royal? Yes f ''yes'', give name and relationship PERSONAL REFERENCES Give the names and addresses of three persons, not relatives or former employers, who know you. Date of Birth Height Have you ever been convicted of a crime other than a minor traffic violation? Yes f yes, please explain. Weight Have you ever been convicted of a crime other than a minor traffic violation? Yes f yes, please explain. PLEASE READ THE FOLLOWNG STATEMENTS CAREFULLY AND SGN. ~ certify that all answers given herein are true and complete to the best of my knowledge. hereby authorize Port Royal to conduct whatever investigation it deems necessary to confirm statements submitted on this application. f the investigation determines any untrue statements or answers, accept this as sufficient reason for refusal to hire. authorize and request each person, former employer, firm, or corporation, given as reference, to answer any and all questions related to my current and past work performance, character or skills. hereby release from liability, the employer and its representatives for seeking such information and all persons, corporations or organizations for furnishing such information. n the event of employment, understand that false or misleading information given on my application or during my interview s, may result in dismissal. also understand, that am required to abide by all rules and regulations of my employer. As prerequisite to my employment, agree that will consent to and undergo testing to detect the presence of drugs and/or alcohol. f employed by Port Royal, further agree, as a condition of my employment, that at such time or times during my employment as Port Royal shall require, will consent to and undergo testing for the presence of drugs and/or alcohol. also agree that at the time of any such examination. Finally, agree that the results of any such examination shall be made available to Port Royal or its agents. agree to submit myself, upon request for a physical examination by a physician selected by the town and understand that failure to meet the physical requirements may disqualify me for employment. n the event of my employment, understand that have the right to quit or leave my employment with proper notification and further understand, my employer has the right to terminate my employment at any time for any reason in accordance with my employer's sonnel Policies. ~ ~ ~ ~ Applicant's Signature ALL APPLCANTS NOT CONTACTED WTHN 30 WORKNG DAYS AFTER APPLCATON CLOSNG DATE MAY CONSDER THE POSTON FLLED Date ~