JOB APPLICATION FORM

Date of Application: /
Month / Day / Year

Applicant’s Name: ______

Phone #:______E-Mail address:______

Date of Birth:
Month / Day / Year

Address: ______Married [ ] single [ ]

Position applying for
If you have served in similar position, please outline years of experience below
Year
From / To / Institution / Position / Reference person / Contact
If you have had formal training for the position, please outline below
Year
From / To / Degree
(certificate, diploma, etc.) / Institution / Reference person / Contact

EDUCATI0N

Put a check mark (√) before the highest level of education you have completed. Attach copies of credentials.

School Name / Address / Degree Earned
High school
College/University
Computer
Vocational

Computer skills: List all computer skills you have acquired (Hardware/Software):

If you are currently in school, would you commit yourself to a full-time work? Yes [ ] No[ ]

Which of the following counties would you be willing to work in? (Check as many as are applicable)

Margibi / Cape Mount / Bomi / Nimba / Bong / Grand Gedeh / Montserrado / Grand Bassa

EMPLOYMENT HISTORY

List past employment history (begin with the most recent). If you are a first time job seeker, then please leave this area blank.

Year / Institution / Address / Position / Duties/Functions / Reason(s) for leaving
From / To
1
2
3
4

Have you ever been convicted of any crime? (Convictions that have been settled either legally or otherwise)

Yes [ ] No[ ]

If your answer is yes, please attach explanation

References (Names of persons who can serve as reference for you)

CATEGORY / NAME / ADDRESS / CONTACT
1 / Community Leader
2 / Religious Leader
3 / Last Employer

AGREEMENT

The above information is true and correct. I understand that this process will be terminated, or if I am employed, I shall be subject to dismissal, if any information given on this form is found to be false or if I have withheld relevant information.

______

Signature Date

FOR LBDI USE ONLY. DO NOT WRITE BELOW THIS NAME.

Action / Personnel / Comment / Signature / Date
Aptitude test
Preliminary interview
Departmental interview
Interview panel
Interview panel
Interview panel
Interview panel
Interview panel
Interview panel