Mail Employment Application to:
City of Columbia Human Resources Office
1225 Lady Street Columbia, SC 29201 OR
PO Box 147 Columbia, SC 29217-0147
For questions, call (803) 545-3010

City of Columbia

SUMMER APPLICATION

Job Vacancies– visit

Application For Employment

Resume Attached? Yes No Are you 18 years of age or older? Yes No (Applicant’s under 18 years of age MUST submit proof of age with their application. If under 18, parent or legal guardian must also sign in space provided on page 2)

Personal InformationPlease print all information Today’s Date:

Job (Position) Applying For: / HR (USE ONLY)
Job (Position) Applying For: / HR (USE ONLY)
Job (Position) Applying For: / HR (USE ONLY)
Last Name First Name Middle Name / Home Phone Cell Phone
Current Address City State Zip / Work schedule Preferred:
Full Part time Temporary
Part- time Hours?
Email Address / Work Phone
(May we call you at work?) Yes No
Have you ever worked under another name? Yes No
If yes, What name? / Did you ever serve in the Armed Forces?
Yes No
Do you possess a VALID driver’s license? Yes No Commercial Driver’s License? Yes No
License # State Issued: Class Type? License Expiration Date:
Endorsements? (If yes, Identify) Restrictions (If yes, Identify) / Are you a previous City Employee?
Yes No
If yes, what was your Employee ID #:
Are you legally eligible for employment in the United States? Yes No
(Proof of eligibility will be required before you can be employed.) / When will you be available to begin work?
Are you currently related to any employees of City of Columbia? Yes No If yes, please list name(s), location(s) and relationship.
Name Location Relationship_____
Name Location Relationship______

Education and Training

High School or GED City / State Circle Years Completed 1 2 3 4 Degree Did you graduate? Yes No
College (undergraduate) City / State Circle Years Completed 1 2 3 4 Degree Did you graduate? Yes No
College (postgraduate) City / State Circle Years Completed 1 2 3 4 Degree Did you graduate? Yes No

Other Training, Educational Programs and Certifications

Program/Training Course Name Dates Program/Training Course Description Dates
Certifications (Types and Dates)

March 2013

Employment History (Must also be completed even if you are submitting a resume) / Please give accurate, complete full-time and part-time employment information. Start with your most recent employer.
Company Name / Telephone
Address City State Zip / Employed (Month and Year)
From To
Name of Supervisor Your Job Title / Pay Rate
Start $ End $
Describe your duties / Reason for leaving
Company Name / Telephone
Address City State Zip / Employed (Month and Year)
From To
Name of Supervisor Your Job Title / Pay Rate
Start $ End $
Describe your duties / Reason for leaving
Company Name / Telephone
Address City State Zip / Employed (Month and Year)
From To
Name of Supervisor Your Job Title / Pay Rate
Start $ End $
Describe your duties / Reason for leaving

References:

Name Address Phone:__

Name Address Phone:__

Have you EVER been convicted of any Criminal Offense (s)? Yes No (Conviction will not necessarily disqualify you from employment)
Have you EVER been convicted or entered a plea of guilty or no contest to any crime, then you must list it. Even if you only paid a fine, forfeited bond, or received a suspended sentence. You must also list any criminal charges currently pending against you. Convictions for Driving Under the Influence or Driving Under Suspension must be Listed. If additional space is needed, please attach a separate sheet of paper.
Conviction (s) / Where Convicted / Arresting Authority & City / State / Date (Month / Year) / Court Disposition
Conviction (s) / Where Convicted / Arresting Authority & City / State / Date (Month / Year) / Court Disposition
Conviction (s) / Where Convicted / Arresting Authority & City / State / Date (Month / Year) / Court Disposition

As an applicant for employment I understand and accept the following:

1)Any misrepresentation or falsification of information or significant omissions may be cause for rejection of my application or for subsequent discipline up to and

includingtermination if discovered at a later date.

2)I may be required to pass a medical physical and the results of which may be grounds for a withdrawal of or termination of employment.

3)My employment is contingent upon a drug and/or alcohol screen, the results of which may be grounds for disqualifying me from employment.

4)I understand that the City of Columbia will not discriminate against any employee or applicant because of age, religion, sex, race, color, national origin, disability,

or veteran status.

5)I understand that a background check will be conducted and could include checks on my prior work experience, educational background, criminal record, social

security trace, motor vehicle and credit. I also understand that once employed I am subject to additional background investigations, as appropriate.

6)I understand that this application or any part thereof, is NOT a contract for employment.

7)I understand that this application will remain active for two (2) months from the date submitted.

8)I authorize and consent to my current and prior employers, educational institutions, persons or organizations named in this application (or accompanying resume

and financial institutions and other agencies to release any information that may be required to make an employment decision and release all parties from all

liability for any damage thatmay result from providing this information.

Applicant Signature ______Date: ______

Parent or Legal Guardian’s

Original Signature ______Date: ______

March 2013

Rev.March 2013 / CITY OF COLUMBIA REPORTING FORM / Page 3
ALL APPLICANT’S / MUST / COMPLETE THE FOLLOWING SECTIONS OF THIS REPORTING FORM
NAME: / S.S. #: / - / -
How did youFIRSThear about this position? CHECK OR X ONE of the following?
 / 1 / City’s Job Posting (Location): /  / 5 / Internet (Site) – Identify: /  / 9 / Newspaper – Name of Newspaper:
 / 2 /

City Hall Walk-In

/  / 6 / Job Fair – Identify Where: /  / 10 / Referred by – Name:
 / 3 / City’s Web Site (columbiasc.net/jobs) /  / 7 / Job Service – One Stop /  / 11 / Other – Identify:
 / 4 / Employment Agency (Name): /  / 8 / Journal/Publication – Name: / 

NOTE: The information requested ABOVE is needed to analyze and assure compliance with Federal Equal Employment Opportunity laws, as well as meet the reporting requirements of those laws. YOUR SIGNATURE IS REQUIRED (SEE BELOW).

EQUAL EMPLOYMENT OPPORTUNITY REPORTING AND RESEARCH FORM
THIS FORM IS RETAINED IN THE HUMAN RESOURCES OFFICE FOR RECORD KEEPING PURPOSES ONLY.
SEX (Check or X One): / DATE OF BIRTH: / - / -
MALE / FEMALE
POLICE OFFICER APPLICANTS ONLY:
Are you 21 Years of age or older? /

All Applicants

Are you 18 years of age or older?
Yes / No / Yess / No
ETHNIC GROUP (Check or X One of the following):
Caucasian (White) Non-Hispanic (W) / Asian or Pacific Islander (AP)
African-American (Black) Non-Hispanic (B) / American Indian or Alaskan Native (AI)
Hispanic (H) / Other:
MISCELLANEOUS: Identify any REASONABLE ACCOMMODATIONS that would be needed to perform the essential functions of the position(s) for which you are applying:
NOTE: The information requested above regarding race, color, sex, age, national origin, disability status and reasonable accommodation, for qualified individuals with disabilities, is needed to analyze and assure compliance with Federal Equal Employment Opportunity laws, as well as meet the reporting requirements of those laws. Your cooperation in providing this information is important to the success of our equal employment opportunity and affirmative action programs.
This EEO Reporting and Research Form will be retained in the Human Resources Office with your original application. Human Resources Office only sends a copy of your application to the Hiring Authority. The information contained in this form will not be used in the hiring or interviewing process and will be available only to authorized personnel for research and evaluation purposes. Refusing to provide this information will not subject you to adverse treatment.
TO THE BEST OF MY KNOWLEDGE, THE INFORMATION CONTAINED IN THIS FORM IS TRUE AND CORRECT.
(APPLICANT'S SIGNATURE - IN INK) / Today’s Date
EMPLOYMENT OFFICE USE ONLY - DO NOT COPY – DO NOT SEND

(If this application has been downloaded from the City’s Web Page – make sure this is all on Page 4 A ONLY).