Sawyer County Application for Employment

Human Resources Department

10610 Main Street, Suite 23

Hayward WI 54843

voice: (715) 634-7554 x2226

email: rose.lillyroot@sawyercountygov.org

Position applying for *

Department *

Last Name *

First Name *

MiddleInitial *

Address *

City *

State *

Zipcode

Phone *

Alternate Phone

Fax

Enter your email address to receive a copy of the form you are submitting along with your answers.

SAWYER COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER

Sawyer County considers applicants for all positions without regard to race, color, creed, sex, national origin, age, ancestry, marital status, disability, sexual orientation, arrest record, conviction record, membership in the National Guard, state defense force, or any other reserve component of the military forces of the United States or this state, or the use or non-use of lawful products off the employer’s premises during non-working hours, or any other legally protected status. If you have a disability which requires an accommodation, please contact the Human Resources Manager at 715 634-7554 X2226 or email hrdirector@sawyercountygov.org so appropriate arrangements can be made to allow you to participate in the selection process.

CERTIFICATION, AUTHORIZATION & RELEASE

I certify that the information given by me on this application is true and correct and without omissions to the best of my knowledge. I understand and agree that any misrepresentation or deliberate omission of a fact during the application process may result in a rejection of my application or, if employed, a termination from employment.

I further understand that the County will make a thorough investigation of my entire work history and may verify all data given in my application for employment, related papers, or oral interviews. I consent to and authorize release of information requested by the County or its agents and I release from liability any person giving or receiving any such information.

I agree that my employment may be terminated by the County at any time without liability for wages or salary except such as may have been earned at the date of such termination unless otherwise agreed to in writing.

Although County management makes every effort to accommodate individual preferences, business needs may at times make the following conditions mandatory: overtime or work schedules other than usual work hours as business needs dictate. I understand and accept these conditions of employment, if hired.

Receipt of the application by the County for consideration does not constitute a promise to interview or to offer employment with Sawyer County. I also understand that the County does not accept personal resumes alone for consideration in the employment process and will consider this application as completed, along with a resume if submitted, when reviewing candidates for an employment vacancy.

I further understand that I may be asked to undergo a physical examination, including substance abuse screening, prior to an appointment to a position with Sawyer County and that I may be subject to substance abuse screening after employment. I understand that refusal to participate in a requested pre-employment substance abuse screening will result in the rejection of my application.

Please indicate if you accept the above terms. *

I Agree

I Disagree

EMPLOYMENT HISTORY

Begin with most recent - - at least past ten years

Employer 1

Date employed from:

To:

Job Title:

Duties:

Company name:

Company address, city, state, zip

Supervisor name

Supervisor contact information: (phone or email)

Starting annual salary or hourly wage:

Ending annual salary or hourly wage:

Reason for leaving

May we contact employer/supervisor? *

Yes

Employer 2

Date employed from:

To:

Job Title:

Duties

Company name:

Company address, city, state, zip

Supervisor name

Supervisor contact information: (phone or email)

Starting annual salary or hourly wage:

Ending annual salary or hourly wage:

Reason for leaving

May we contact employer/supervisor? *

Yes

Employer 3

Date employed from:

To:

Job Title:

Duties

Company name:

Company address, city, state, zip

Supervisor name

Supervisor contact information: (phone or email)

Starting annual salary or hourly wage:

Ending annual salary or hourly wage:

Reason for leaving

May we contact employer/supervisor?

Yes

Employer 4

Date employed from:

To:

Job Title:

Duties

Company name:

Company address, city, state, zip

Supervisor name

Supervisor contact information: (phone or email)

Starting annual salary or hourly wage:

Ending annual salary or hourly wage:

Reason for leaving

May we contact employer/supervisor?

Yes

Educational Background

High School name and address

High School degrees and majors

College name and address

College degrees and majors

Technical school name and address

Tech School degrees and majors

License/s or Certification/s Held:

MILITARY SERVICE

Branch of service

Mo/Yr Served From/To

Active Duty or Reserve?

Highest Grade

Skill specialty or primary duty

List Special Schools Attended/Skills Acquired During Military Service

OTHER QUALIFICATIONS

ARE THERE ANY OTHER EXPERIENCES, SKILLS OR QUALIFICATIONS WHICH YOU THINK WOULD
ESPECIALLY QUALIFY YOU FOR EMPLOYMENT WITH THE COUNTY?

Cover Letter (optional) 🛈

Resume or other electronic documentation you would like to provide 🛈

PROFESSIONAL REFERENCES

1. Name, title or position, address, city, state, zip and phone number

How long has this person known you?

2. Name, title or position, address, city, state, zip and phone number

How long has this person known you?

3. Name, title or position, address, city, state, zip and phone number

How long has this person known you?

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Sawyer County Human Resources Department