APPLICATION FOR EMPLOYMENT ORANGEBURG COUNTY ...

ReferencesList three references who are not relatives or previous supervisors:NameTelephone NumberList any friends or relatives currently employed by Orangeburg County:For Office Use Only:I hereby affirm that all statements made on this application are true and correct. I authorize the County toconduct whatever investigation it deems necessary to confirm statements made on this application. I realize thatmy falsification or misrepresentation on this application, or any other personnel record, may result in refusal tohire or discharge.I understand that the County follows an employment at-will policy and that either the County or myself mayterminate my employment at any time or for any reason consistent with applicable state or federal law. Iunderstand that this application is not a contract, or an offer, of employment.I understand that to be employed, I must be lawfully authorized to work in the United States, and I must show theCounty any required documents to prove this. I agree to submit myself, upon request, for a physical examinationby a physician designated by the County. I also agree to submit to a pre-employment drug/alcohol-screening testand understand that failure to meet medical requirements as applicable to the physical examination ordrug/alcohol-screening test may disqualify me from consideration for employment. Refusal to submit a physicalexamination and/or drug/alcohol-screening test may disqualify me from consideration for employment.Signature:Date:

County of OrangeburgEqual Opportunity Employment FormApplicant InformationPO Drawer 9000Orangeburg, SC 29116-9000www.OrangeburgCounty.orgFull Name:Address:Last First M.I.Street Address Apartment/Unit #City State ZIP CodeHome Phone: ( ) Social Security Number:Position Applied for:Voluntary InformationThis information is being requested in accordance with federal regulations. The information is voluntary andwill not be used when considering you for employment with our company.Racial or Ethnic GroupGenderAmerican Indian/Alaskan Asian/Pacific Islander Black/African AmericanHispanic/Latino White/Caucasian OtherFemaleMaleMilitary ServicePre-Vietnam EraPost-Vietnam EraVietnam EraDisabled VeteranHow did you hear about this position?Newspaper Company Employee Professional PublicationJob Fair Placement Office Web SiteOther _________________