Employment Opportunities Step 1 of 6 - PERSONAL INFORMATION 0% Chatham County ABC Board Employment Application EQUAL OPPORTUNITY EMPLOYEMENT It is the policy of the Chatham County ABC Board to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, marital status, status with regard to public assistance, status as a disabled veteran, recently separated or other covered veteran, or any other characteristic protected by federal, state, or local law. PLEASE READ BEFORE BEGINNING Fill out all sections completely and to the best of your ability. All questions are considered important for employment and no other use is intended for the information you submit. Once submitted, all application materials become property of the Chatham County ABC. This application is designed to protect individual rights and privacy all while ensuring equal employment opportunity. In what position are you interested?(Required)SelectPart-Time Sales Clerk for Wilsonville location. 19 hours, evening and weekendsAny available positionEmployee Information First Name(Required) Middle Name Last Name(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address (if different than above) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Alternate PhoneEmail(Required) Are you legally authorized to work in the US?(Required) Yes No Are you at least 18 years of age?(Required) Yes No Position applied for:(Required) Store staff Warehouse staff Office staff Other If you selected other, then what position are your applying for? Are you seeking?(Required) Full Time Part Time Temporary/Seasonal Anything available Have you ever applied with Chatham County ABC before?(Required) Yes No Have you ever been employed with Chatham County ABC before?(Required) Yes No Are you related in any way to any person currently employed with Chatham County ABC?(Required) Yes No If yes to the question above, please give their name and relationship: If offered a position, when would you be available to start? Highest level of education completed? High School GED College Graduate School Name of your High School Address Street Address Address Line 2 City State / Province / Region Dates attended? From: MM slash DD slash YYYY To: MM slash DD slash YYYY Did you graduate? Yes No Major or course of study Name of your Vocational/Technical Address Street Address Address Line 2 City State / Province / Region Dates attended? From: MM slash DD slash YYYY To: MM slash DD slash YYYY Did you graduate? Yes No Major or course of study Name of your College/University Address Street Address Address Line 2 City State / Province / Region Dates attended? From: MM slash DD slash YYYY To: MM slash DD slash YYYY Did you graduate? Yes No Major or course of study Name of your Graduate/Professional Address Street Address Address Line 2 City State / Province / Region Dates attended? From: MM slash DD slash YYYY To: MM slash DD slash YYYY Did you graduate? Yes No Major or course of study Answer the questions for each period of employment. Include any military service. Begin with your present or latest employment and use additional sheets in the same format if necessary. Be sure to account for gaps in your employment history. “See attached resume” is not acceptable.May we contact anyone listed below? Yes No Maybe (explain) If maybe, please explain.Employer OneEmployer or Company Name Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Supervisor's Name Supervisor's Title Supervisor’s PhoneSupervisor’s Email Starting Salary Ending Salary Dates worked? From: MM slash DD slash YYYY To: MM slash DD slash YYYY May we contact your previous employer? Yes NO Brief description of job responsibilitiesBrief description of reason for leaving: Employer TwoEmployer or Company Name Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Supervisor's Name Supervisor's Title Supervisor’s PhoneSupervisor’s Email Starting Salary Ending Salary Dates worked? From: MM slash DD slash YYYY To: MM slash DD slash YYYY May we contact your previous employer? Yes NO Brief description of job responsibilitiesBrief description of reason for leaving: Employer ThreeEmployer or Company Name Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Supervisor's Name Supervisor's Title Supervisor’s PhoneSupervisor’s Email Starting Salary Ending Salary Dates worked? From: MM slash DD slash YYYY To: MM slash DD slash YYYY May we contact your previous employer? Yes NO Brief description of job responsibilitiesBrief description of reason for leaving: In listing references, submit persons who are not related to you and who have knowledge of your qualifications for the position of which you are applying. Examples would be former supervisors, co-workers, teachers, etc. Do not include supervisors listed already within Employment History.Name PhoneEmail Relationship Name PhoneEmail Relationship Name PhoneEmail Relationship • I certify that, to the best of my knowledge, the statements and information listed are true and complete. • I understand that misrepresented, falsified, or omitted information may disqualify me for employment consideration or result in dismissal from employment with Chatham County ABC. • I authorize Chatham County ABC to collect from me any specimen required for drug screening as pre-employment consideration. • I authorize Chatham County ABC to conduct a full employment background and criminal check using the information that I have provided in this application or during any interview. • I hereby understand and acknowledge that unless otherwise defined by applicable law, any employment relationship with the Chatham ABC is of an “at will” employment. It is further understood that this “at will” employment relationship may not be changed by any written document unless such change is specifically approved by the Chatham County ABC Board. • I hereby understand that I am required to abide by all rules and regulations of the Chatham County ABC.