APPLICATION FOR EMPLOYMENT
RICHLAND COUNTY GOVERNMENT Human Resources Department
2020 Hampton Street, Room 3058 Columbia, SC 29204 Ph: 803-576-2110 – Fax: 803-576-2119 - Employment Website – www.rcgov.us

DATE: ____________________________ POSITION APPLIED FOR: ______________________________________________________________
ONLY ONE POSITION PER APPLICATION INSTRUCTIONS TO APPLICANT: Please type or print legibly in ink all information except signature. Incomplete applications will not be accepted. Applications must have all sections completed and the form signed by the applicant. An application must be completed for each vacancy. A résumé may be attached but not substituted for completing the application. All qualified applications will be referred to the department where the vacancy is located. That Department Head is responsible for the review and evaluation of applications and recommending the most qualified applicants to be selected for an interview. Applications will remain active until the vacancy is filled. If you wish to remain informed of positions available at Richland County, please visit our website at www.rcgov.us. Thank you for your interest in Richland County Government.

PERSONAL DATA
NAME (Last, First, MI): SOCIAL SECURITY NUMBER: MAILING ADDRESS: CITY: HOME PHONE #: STATE: WORK PHONE #: ZIP CODE: COUNTY NUMBER: MAY WE CALL YOU AT WORK: YES _____ NO _______ DATE OF APPLICATION:

ARE YOU LEGALLY AUTHORIZED TO WORK IN THE UNITED STATES?

DO YOU HAVE RELATIVES EMPLOYED BY RICHLAND COUNTY? YES ______ NO _______ IF SO, NAME(S) /RELATION _____________________________________________________________________________ WHAT DEPARTMENT __________________________________________________________________________________

DO YOU POSSESS A VALID DRIVERS LICENSE?

YES

NO

NUMBER

EXP. DATE

HAVE YOU BEEN CONVICTED OR PLED NO CONTEST OF A CRIME OTHER THAN MINOR TRAFFIC VIOLATIONS (I.E. PARKING TICKET)? YES ____ NO ____ **IF YES: CHARGES ____________________________________________________________________________________ WHERE CONVICTED DATE DISPOSITION/STATUS
**NOTE: CRIMINAL OFFENSES INCLUDE FELONIES, MISDEMEANORS AND SUMMARY OFFENSES. EXAMPLES: DRIVING UNDER THE INFLUENCE OF INTOXICATING BEVERAGES, DRUGS, FRAUDULENT OR BAD CHECKS, DISTUBING THE PEACE, LEAVING THE SCENE OF AN ACCIDENT, ROBBERY, ETC. OMIT MINOR VEHICLE VIOLATIONS AND ANY OFFENSE COMMITTED BEFORE YOUR 17TH BIRTHDAY, WHICH WAS FINALLY ADJUDICATED IN JUVENILE COURT OR UNDER A YOUTHFUL OFFENDER LAW. CONVICTION OF A CRIMINAL OFFENSE IS NOT A BAR TO EMPLOYMENT IN ALL CASES. THE NATURE, SEVERITY AND DATE OF THE OFFENSE IN RELATION TO THE POSITION FOR WHICH YOU ARE APPLYING ARE CONSIDERED. FAILURE TO ACCURATELY REPORT OFFENSES WILL BE CONSIDERED SERIOUSLY BY THE COUNTY AND GROUNDS FOR DISQUALIFICATION FROM CONSIDERATION AND/OR TERMINATION IF EMPLOYED.

EDUCATION
Starting with High School, provide COMPLETE information on all schools attended, including special courses or schools. School/Institution and Location
High School or Equivalent Major/Minor Subject Areas Graduate Degree/ Diploma

Yes____ No ____

College/University

Yes____ No ____

College/University

Yes____ No ____

College/University

Yes____ No ____

Technical School

Yes____ No ____

SKILLS
DO YOU HAVE PERSONAL COMPUTER/SOFTWARE SKILLS? DO YOU HAVE WORD PROCESSING SKILLS? DO YOU HAVE DATA ENTRY SKILLS? SUPERVISORY EXPERIENCE/TRAINING? TECHNICAL EXPERIENCE/TRAINING? MILITARY EXPERIENCE/TRAINING? WPM: YES YES YES YES YES YES NO NO NO NO NO NO

LIST ANY EQUIPMENT, SOFTWARE OR MACHINES, WITH WHICH YOU ARE PROFICIENT, RELATED TO THE POSITION FOR WHICH YOU ARE APPLYING: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________