"Georgia Application for Employment" - Georgia (United States)

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STATE OF GEORGIA
APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer
Complete information on searching for jobs with the State of Georgia and an on-line application procedure may be found on the Internet
at thejobsite.org. Using The Job Site is the preferred method of applying for these State jobs.
Daytime Telephone Number
E-mail Address
Last Name
First Name
Middle Initials
Street or Mailing Address
Apartment No.
City
State
Zip Code
County
EMPLOYMENT ELIGIBILITY:
To be employed by the State of Georgia, you must meet certain State and Federal employment eligibility requirements.
These include (but are not limited to) United States citizenship or authorization to work in this country, positive rehire status if previously employed by the State, and no
felony convictions (for some jobs). Please answer the following questions.
1. Are you a United States
2. Are you an alien authorized to work in
3. Have you ever been dismissed from any
4. Have you ever been convicted
citizen?
the United States?
State of Georgia government position?
of a felony?
YES
NO
N/A
YES
NO
YES
NO
YES
NO
If YES, attach an explanation.
If YES, attach an explanation.
TYPE OF WORK:
JOB TITLE AND JOB CODE REQUIRED. If you do not know the correct job titles, information is available at the various State of Georgia
agency personnel offices, the Georgia Merit System Office in Atlanta, the Georgia Department of Labor Career Centers, or on thejobsite.org.
Job Code
Specific Job Title Sought
EDUCATION:
Vocational/Business School:
Field of Study:
No. of
High School Graduate
Completed: Yes
No
Months:
or Equivalent (GED)?
Date: (Mo/Yr)
Yes
No
TYPE OF
DATE
CREDIT
DEGREE
DEGREE
PLEASE LIST EXACT COLLEGE HOURS :
RECEIVED
FIELD/AREA OF CONCENTRATION
COMPLETED
Qtr
Sem
(BA/BS/
COLLEGES/UNIVERSITIES
CITY and STATE
Major
Hrs
Minor
Hrs
(Mo./Yr.)
Hrs
Hrs
MA/PhD)
LANGUAGE SKILLS:
Sign Language
Multilingual (Specify languages) __________________________________________________________
GEORGIA LICENSES AND CERTIFICATIONS:
License/Certificate
Expiration
Specialization/
Type of License/Certificate
Number
(Mo. /Yr.)
Endorsements
Current Valid Driver’s License
Yes
No
Current Valid Commercial Driver’s License (CDL): Class (Check One):
A
B
C
Teacher Certified in Georgia: Type of Certificate Held:
Georgia Peace Officer Standards and Training Certificate (POST)
Other Professional License/Certificate:
CERTIFICATION: Read carefully before signing and dating. Unsigned applications will not be processed.
I certify that all information on this application is correct. I authorize any agent or employee of the State to verify this information and to release it to
anyone who may consider me for appointment. I understand that intentionally providing false information on this form or attachments is a violation of state
law. I also understand that applications submitted electronically, via e-mail or similar media, are not valid unless I enter my name in the
signature field below and such action shall constitute an electronic signature. I further certify that either: 1) I have not been convicted of a drug-
related criminal offense; or 2) if I have been convicted of a drug-related criminal offense, it has been more than three (3) months since my first conviction,
or more than five (5) years since a second or subsequent conviction (O.C.G.A. 45-23 et. Seq.).
Signature:
Date:
Fax: 404-624-7546 or Email:
employment@gsp.net
STATE OF GEORGIA
APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer
Complete information on searching for jobs with the State of Georgia and an on-line application procedure may be found on the Internet
at thejobsite.org. Using The Job Site is the preferred method of applying for these State jobs.
Daytime Telephone Number
E-mail Address
Last Name
First Name
Middle Initials
Street or Mailing Address
Apartment No.
City
State
Zip Code
County
EMPLOYMENT ELIGIBILITY:
To be employed by the State of Georgia, you must meet certain State and Federal employment eligibility requirements.
These include (but are not limited to) United States citizenship or authorization to work in this country, positive rehire status if previously employed by the State, and no
felony convictions (for some jobs). Please answer the following questions.
1. Are you a United States
2. Are you an alien authorized to work in
3. Have you ever been dismissed from any
4. Have you ever been convicted
citizen?
the United States?
State of Georgia government position?
of a felony?
YES
NO
N/A
YES
NO
YES
NO
YES
NO
If YES, attach an explanation.
If YES, attach an explanation.
TYPE OF WORK:
JOB TITLE AND JOB CODE REQUIRED. If you do not know the correct job titles, information is available at the various State of Georgia
agency personnel offices, the Georgia Merit System Office in Atlanta, the Georgia Department of Labor Career Centers, or on thejobsite.org.
Job Code
Specific Job Title Sought
EDUCATION:
Vocational/Business School:
Field of Study:
No. of
High School Graduate
Completed: Yes
No
Months:
or Equivalent (GED)?
Date: (Mo/Yr)
Yes
No
TYPE OF
DATE
CREDIT
DEGREE
DEGREE
PLEASE LIST EXACT COLLEGE HOURS :
RECEIVED
FIELD/AREA OF CONCENTRATION
COMPLETED
Qtr
Sem
(BA/BS/
COLLEGES/UNIVERSITIES
CITY and STATE
Major
Hrs
Minor
Hrs
(Mo./Yr.)
Hrs
Hrs
MA/PhD)
LANGUAGE SKILLS:
Sign Language
Multilingual (Specify languages) __________________________________________________________
GEORGIA LICENSES AND CERTIFICATIONS:
License/Certificate
Expiration
Specialization/
Type of License/Certificate
Number
(Mo. /Yr.)
Endorsements
Current Valid Driver’s License
Yes
No
Current Valid Commercial Driver’s License (CDL): Class (Check One):
A
B
C
Teacher Certified in Georgia: Type of Certificate Held:
Georgia Peace Officer Standards and Training Certificate (POST)
Other Professional License/Certificate:
CERTIFICATION: Read carefully before signing and dating. Unsigned applications will not be processed.
I certify that all information on this application is correct. I authorize any agent or employee of the State to verify this information and to release it to
anyone who may consider me for appointment. I understand that intentionally providing false information on this form or attachments is a violation of state
law. I also understand that applications submitted electronically, via e-mail or similar media, are not valid unless I enter my name in the
signature field below and such action shall constitute an electronic signature. I further certify that either: 1) I have not been convicted of a drug-
related criminal offense; or 2) if I have been convicted of a drug-related criminal offense, it has been more than three (3) months since my first conviction,
or more than five (5) years since a second or subsequent conviction (O.C.G.A. 45-23 et. Seq.).
Signature:
Date:
Fax: 404-624-7546 or Email:
employment@gsp.net
WORK HISTORY
: Describe your work history below beginning with your current or most recent job. Include military and volunteer experience. If you
worked for the same employer but held different jobs describe each separately. Describe in detail the specific duties beginning with your primary duties. If you
need more space, print out the supplemental work history page and attach to the application. Failure to give complete and detailed information regarding each job
held may result in your disqualification from employment consideration. You may submit a resume to document your work background. However, if the resume
does not contain all information requested in the Work History section, please fill in that information on the application. Include additional documents as requested.
Current or Last Employer:
Your Job Title:
Address
From (mo/yr)
To (mo/yr)
Hours per Week:
City
GA
Zip Code
Check all that apply:
Annual Salary
Volunteer
Intern
Paid
Your Supervisor’s Name and Title
Your Supervisor’s Phone Number
May We Contact Employer?
YES
NO
( )
Reason for Leaving
# and types of employees you supervised:
Describe in detail your job duties.
Related Computer Skills:
Employer:
Your Job Title:
Address
From (mo/yr)
To (mo/yr)
Hours per Week:
City
State
Zip Code
Annual Salary
Check all that apply:
Volunteer
Intern
Paid
Your Supervisor’s Name and Title
Your Supervisor’s Phone Number
May We Contact Employer?
YES
NO
(
)
Reason for Leaving
# and types of employees you supervised:
Describe in detail your job duties.
Related Computer Skills :
Employer:
Your Job Title:
Address
From (mo/yr)
To (mo/yr)
Hours per Week:
City
State
Zip Code
Annual Salary
Check all that apply:
Volunteer
Intern
Paid
Your Supervisor’s Name and Title
Your Supervisor’s Phone Number
May We Contact Employer?
YES
NO
(
)
Reason for Leaving
# and types of employees you supervised:
Describe in detail your job duties.
Related Computer Skills :
Fax: 404-624-7546 or Email: employment@gsp.net
STATE OF GEORGIA EMPLOYMENT AVAILABILITY
Where do you want to work? List up to nine (9) Communication centers in the blanks below. Use the letter codes of each center.
1.
2.
3.
4.
5.
6.
7.
8.
9.
GSP DISPATCHER APPLICANTS PLEASE SELECT FROM THE FOLLOWING COMMUNICATION CENTERS
Statesboro-(F)
Cartersville-(A)
10723 US 301 South
130 State Route 20 Spur
Statesboro, GA 30458
Cartersville, GA 30120
Americus-(G)
Gainesville-(B)
113 William Bowen Pointe
2000 Cleveland Hwy
Americus, GA 31709
Gainesville, GA 30506
Tifton-(H)
Atlanta-(C)
3101 US Hwy 41 South
959 East Confederate Ave
Tifton, GA 31794
Atlanta, GA 30316
Brunswick-(I)
Newnan-(D)
160 Public Safety Blvd
517 Turkey Creek Rd
Brunswick, GA 31525
Newnan, GA 30263
Grovetown-(E)
2000 William Few Parkway
Grovetown, GA 30813
Where do you want to work? List up to nine (9) Regions in the blanks below. Use the number codes of each region.
1.
2.
3.
4.
5.
6.
7.
8.
9.
MOTOR CARRIER COMPLIANCE WEIGHT INSPECTOR APPLICANTS PLEASE SELECT FROM THE FOLLOWING REGIONS
Region 1 Inspection Station(s)
Region 6 Inspection Station(s)
Catoosa County Inspection Station
Monroe County Inspection Station
I-75 South (Mile Marker 343)
I-75 North Mile Marker 190
Ringgold, GA 30736
Forsyth, GA 31029
Region 2 Inspection Station(s)
Region 7 Inspection Station(s)
Franklin County Inspection Station
Bryan County Inspection Station
I-85 South Mile Marker 169
I-16 West Mile Marker 144
Lavonia, GA 30553
Ellabell, GA 31308
Region 3 Inspection Station(s)
Chatham County Inspection Station
I-95 Mile Marker 111
Douglas County Inspection Station
Pt. Wentworth, GA 31407
I-20 East Mile Marker 43
1786 Blairs Bridge Rd
Region 8 Inspection Station(s)
Lithia Springs, GA 31022
Lowndes County Inspection Station
Carroll County Inspection Station
I-75 South Mile Marker 23
I-20 West Mile Marker 15
Tifton, GA 31793
Temple, GA 30179
Region 9 Inspection Station(s)
Region 4 Inspection Station(s)
McIntosh County Inspection Station
Columbia County Inspection Station
I-95 North Mile Marker 55
I-20 East Mile Marker 187
Darien, GA 31305
Please Note: Applicants for Motor Carrier
Harlem, GA 30614
Compliance Officer, a location will be decided
based on need.
Region 5 Inspection Station(s)
For all other applicants, please refer to specific
Troup County Inspection Station
job posting for position location information.
I-85 South Mile Marker 23
Lagrange GA 30240
Fax: 404-624-7546 or Email: employment@gsp.net
EVALUATION PROCEDURES-(THIS DOES NOT APPLY TO DEPARTMENT OF PUBLIC SAFETY CANDIDATES)
Written Tests:
To obtain a job in certain fields, such as criminal justice and secretarial, you must pass a written and/or performance test. The test scheduling process
is shown below. Proper identification with your picture and signature, such as a driver’s license, is required for admission to all examinations.
Walk-in Examinations: T
ests are offered on selected days in Atlanta only on a walk-in basis. If you wish to test in Atlanta, apply online or bring a completed
application with you. Some testing outside of Atlanta is also done on a walk-in basis. The “Walk-In Testing Schedule” is available on our Web site at thejobsite.org.
You may also call (404) 656-2724 and request a copy of this schedule.
Scheduled or Reserved Seating Examinations:
Written tests are offered on certain Saturdays in selected cities. If you request a scheduled examination and
your application is approved, you will receive an admission slip by mail for the next available test session showing the address of the testing center you have chosen
and the date and time of your appointment. This may take a month or longer due to limited seating.
Select ONE city where you wish to take a written test on Saturday:
Clarkesville – [F]
Americus - [Y]
Augusta - [S]
Sandersville - [M]
Rome - [E]
Savannah - [H]
Thomasville - [U]
Waycross - [L]
Retest Policy:
Your score will normally remain on the list of available applicants for six months from the date of your examination (and, in many cases, you may also
extend your score for an additional six months). Generally, you can apply to be evaluated or to take a written test for the same job only three times in one year, with a
minimum 30 day waiting period between examinations. Upon re-examination, the higher of your scores will generally be kept. The lower score will not be accessible to
employing agencies.
ACCOMMODATIONS FOR APPLICANTS WITH DISABILITIES
For Merit System Walk–in or Scheduled testing purposes only, do you require special examination accommodations because of a
disability? If so, attach a note to this application asking us to call. PRIOR ARRANGEMENTS ARE NECESSARY. Note that in
order to receive accommodations for testing, you must (1) tell the Merit System you need an examination accommodation at least one
(1) day PRIOR to the test; (2) have the accommodation authorized BEFORE being tested; and (3) provide documentation to show the
need for the accommodation (if requested by the Merit System). If you have questions about this process and have a hearing or speech
impairment, please call the Georgia Relay at 1-800-255-0056 or 7-1-1 (TTY/text phone) or 1-800-255-0135 (standard phone). If you
need the State of Georgia Application in an alternate format, please call the Georgia Merit System at (404) 656-2725
:
Training and Experience Ratings
If you apply for a job that does not require a written test, your evaluation will be based on the experience, education, and
training you describe on your application. You will also be evaluated on any supplemental information you may be asked to provide.
VETERAN’S PREFERENCE:
to passing examination scores
The laws of the State of Georgia require that points be added
for certain veterans and
combat troops of the Armed Forces of the United States. The following types of preference are currently granted. If you want to apply for Veteran’s Preference, check
the type below and attach copies of the appropriate document(s) to your application. Copies cannot be returned. (SPB 16.102)
DECEASED VETERAN’S SPOUSE: DD214; marriage certificate;
VETERAN: DD214 showing dates of service and type of discharge
veteran’s death certificate or casualty report
DISABLED VETERAN’S SPOUSE: DD214; marriage certificate;
DISABLED VETERAN: DD214; certificate of service-connected
disabled veteran’s documents dated within last 6 months (veteran
disability (at least 10%) from the V.A. dated within the last 6
months
must have 100% disability)
Date:
Requisition Number (for announced jobs only):
EQUAL EMPLOYMENT OPPORTUNITY INFORMATION
The information you give in this section is optional. It is used by the Georgia Merit System and other state agencies to
comply with Federal guidelines for monitoring the equal employment opportunity efforts of the State of Georgia.
First Name
Last Name
MI
Ethnic Background (Check One):
Gender
Birth Date
MO
DAY
YR
1.
American Indian
2.
White, not of Hispanic origin
(Check One):
3.
Hispanic
4.
Black, not of Hispanic origin
Male
Birth Date - Required for
5.
Asian/Pacific Islander
6.
Multi-racial
Female
some law enforcement
jobs.
For Agency Use
Fax: 404-624-7546 or Email:
employment@gsp.net