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Step One

APPLICATION FOR EMPLOYMENT
Applications must be complete. Incomplete or unsigned applications are subject to disqualification.
Position Applying For:*
Date of Application:*
Last Name:*
First Name:*
Middle Initial:
Address
Street: *
City*
State*
Zip*
Home Phone:*
Cell Phone:
Do You Have A Valid Driver's License?*
1. Yes
2. No
State Issued:
Have You Ever Been Employed By DeSoto County?*
1. Yes
2. No
If Yes, Please Provide Dates: *
Are You Currently Employed?*
1. Yes
2. No
May We Contact You Current Employer?*
1. Yes
2. No
Are You Able To Work?*
1. Full Time
2. Part Time
3. Weekends
Are You Able To Work Overtime?*
1. Yes
2. No
On What Date Would You Be Available To Begin Work?*
On What Date Would You Be Available To Begin Work?
Minimum Salary Acceptable:*
Have You Ever Been Convicted Of, Or Plead Guilty Or No Contest To, A Crime Other Than A Minor Traffic Offense?*
1. Yes
2. No
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Step Two

Step Three

Employment History
Employer #1
Employer:
Contact Name/Position:
Telephone:
Address:
Job Title:
Hourly Rate/Salary: Start
Hourly Rate/Salary: Finish
Dates Of Employment: Start
Dates Of Employment: Start
Dates Of Employment: Finish
Dates Of Employment: Finish
Work Performed:
Reason For Leaving:
May We Contact?
1. Yes
2. No
Employer #2
Employer:
Contact Name/Position:
Telephone:
Address:
Job Title:
Hourly Rate/Salary: Start
Hourly Rate/Salary: Finish
Dates Of Employment: Start
Dates Of Employment: Start
Dates Of Employment: Finish
Dates Of Employment: Finish
Work Performed:
Reason For Leaving:
May We Contact?
1. Yes
2. No
Employer #3
Employer:
Contact Name/Position:
Telephone
Address:
Job Title:
Hourly Rate/Salary: Start
Hourly Rate/Salary: Finish
Dates Of Employment: Start
Dates Of Employment: Start
Dates Of Employment: Finish
Dates Of Employment: Finish
Work Performed:
Reason For Leaving:
May We Contact?
1. Yes
2. No
Comments:
Include Explanations For Any Gaps In Employment
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Step Four

Personal/Professional References
Please Give Atleast Three (3) References Who Do Not Include Family Members or Former Employers.
Reference #1
Name:*
Title:*
Relationship To You:*
Telephone: *
Years Known:*
Reference #2
Name:*
Title:*
Relationship To You:*
Telephone:*
Years Known:*
Reference #3
Name*
Title:*
Relationship To You:*
Telephone:*
Years Known:*
Reference #4
Name:
Title:
Relationship To You:
Telephone:
Years Known:
Reference #5
Name:
Title:
Relationship To You:
Telephone:
Years Known:
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Step Five

Applicants Statement:
I certify that all the information submitted are true, correct and made in good faith.
I am aware that any omissions, falsifications, misstatements or misrepresentations above may disqualify me for employment consideration and if I am hired, may be grounds for termination at a later date. I understand that any information I may give in this application or in the continuing application process may be subject to verification and investigation. I consent to the release of information about my ability and employment history from employers, schools, law enforcement agencies, and other individuals and organizations to our HR staff and other authorized representatives of the DeSoto County Board of Supervisors for employment purposes. The application for employment shall be considered active for a period of time not to exceed ninety (90) days. At the expiration of said ninety (90) day period, the application will be void, and an applicant must file a new application as required under Section 2.100 of the DeSoto County Personnel Manual to be considered for employment in a position with DeSoto County. 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 an authorized executive of this organization. I also understand by signing this document I hereby agree to a drug screen test and background check and understand, also, that I am required to abide by all policies and regulations of the employer.
Signature of Applicant:*
Date:*
Date:
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Step Six

FAIR CREDIT REPORTING ACT DISCLOSURE & AUTHORIZATION
Disclosure
In considering you as an applicant for employment or as a current employee, we may choose to secure and use information contained in either a consumer report or investigative consumer report about you obtained from a consumer reporting agency when: (1) considering your application for employment (2) making a decision whether to offer you employment (3) deciding whether to continue your employment or (4) making other employment-related decisions directly affecting you. For explanation purposes, a "consumer reporting agency" is a person or business that, on a cooperative nonprofit basis, or for monetary fees or dues, regularly assembles or evaluates consumer credit information or other information on consumers for a person who has a legitimate business need for the information or intends to use the information for employment purposes. A "consumer report" means any written, oral or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing your eligibility for employment purposes. An "investigative consumer report" means a consumer report or portion thereof in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your neighbors, friends, or associates reported on or with others with whom you are acquainted or who may have knowledge concerning any such items of information. In the event a investigative consumer report is prepared, you may request additional disclosures regarding the nature and scope of the investigation requested as well as a written summary of your rights under the Fair Credit Reporting Act.
Authorization
By your signature below, you hereby authorize us to obtain a consumer report from a consumer reporting agency, or other permissible source and/or an investigative report about you and to consider this information when making decision regarding your employment. I understand that I have rights under the Fair Credit Reporting Act, including the rights discussed above in order to consider you for employment. If hired, this authorization shall remain on file and shall serve as an ongoing authorization for us to procure consumer reports at any time during the employment period.
Signature of Applicant:*
Date:*
Date:

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