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APPLICATION LAURENS COUNTY HUMAN RESOURCES
POBOX445
FOR EMPLOYMENT LAURENS, SOUTH CAROLINA 29360
(864) 984-3691
We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or
veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.
Position (s) Applied For
How Did You Learn About Us? D Advertisement
D Employment Agency
Last Name
Address Number Street
Telephone Number(s)
D
D
(PLEASE PRINT)
Friend
Relative
First Name
City
D
D
Do you have a valid S.C. Driver's License? If yes, list License
Walk-In
Other
Number List Driver's License Classification ______ _
Have you ever filed an application with us before?
State
If Yes, give date
Have you ever been employed with us before?
Are you currently employed?
May we contact your present employer?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment.
On what date would you be available for work?
Are you available to work: DFull Time DPart Time
If Yes, give date
DShift Work
Are you currently on "lay-off' status and subject to recall?
Can you travel if a job requires it?
Date of Application
Middle Name
Zip Code
Last four of Social Security Number
DYES ONO
DYES
DYES
DYES
DYES
DYES
OTemporary
DYES
DYES
ONO
ONO
ONO
O NO
ONO
ONO
ONO
Have you ever been convicted of, or pled guilty, or no contest to, anycrime other than a minor traffic violation? YES NO
TO
TO
TO
TO
FOR HUMAN RESOURCES DEPARTMENT ONLY
