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First Name: *
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Last Name: *
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Address: *
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City: *
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State: *
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Zip: *
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Email Address: *
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Phone Number (Home): *
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Phone Number (Work):
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NewField
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Have you ever applied with Surfside Beach before?: *
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If yes, when?
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Have you ever worked for Surfside Beach before?: *
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If yes, when and what position?:
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Do you have a relative(s) employed by Surfside Beach?: *
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If yes, give name and department:
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Have you ever been convicted of, pled guilty to, or pleaded no-contest to a crime (other than minor traffic violation)?:
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Charge:
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Place:
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Date:
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Disposition:
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Are there any charges/indictments pending against you now?: *
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If yes, explain:
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Do you have a valid drivers license?: *
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License Number:
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State:
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Expiration Date:
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Has your license ever been suspended or revoked?: *
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If yes, provide details:
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Highest level of education completed: *
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Date completed: *
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Position(s) applying for: *
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Minimum acceptable salary (per yr):
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Preferred employment status:
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Please indicate days available for work: *
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Do you have transportation to and from work?: *
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What hours are you available to work? (from what to what):
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If necessary, will you work overtime?: *
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If necessary, will you work shifts?: *
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Have you been denied bonding?: *
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If yes, please give details:
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Type of license:
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License #:
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Expiration date:
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Typing:
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If yes, WPM:
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Shorthand:
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If yes, WPM and method:
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Transcription:
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If yes, WPM:
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Please list any other pertinent experience, skills, or training that are related to the position for which you are applying:
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Date available to start: *
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Are you presently employed?: *
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May we call you at work?: *
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Have you ever been discharged or forced to resign from a position?: *
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If yes, explain details:
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Current or most recent position title: *
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Employer name: *
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Employer address: *
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Date employed: *
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To: *
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Starting salary: *
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Last salary: *
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Name on employment records if different from present name:
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Description of specific duties: *
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Reason for leaving: *
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Current or most recent position title:
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Employer name:
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Employer address:
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Date employed:
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To:
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Starting salary:
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Last salary:
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Name on employment records if different from present name:
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Description of specific duties:
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Reason for leaving:
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Current or most recent position title:
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Employer name:
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Employer address:
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Date employed:
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To:
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Starting salary:
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Last salary:
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Name on employment records if different from present name:
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Description of specific duties:
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Reason for leaving:
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Current or most recent position title:
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Employer name:
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Employer address:
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Date employed:
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To:
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Starting salary:
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Last salary:
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Name on employment records if different from present name:
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Description of specific duties:
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Reason for leaving:
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Current or most recent position title:
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Employer name:
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Employer address:
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Date employed:
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To:
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Starting salary:
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Last salary:
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Name on employment records if different from present name:
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Description of specific duties:
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Reason for leaving:
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Reference Name #1:
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Address:
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Phone:
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Reference Name #2:
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Address:
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Phone:
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Reference Name #3:
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Address:
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Phone:
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Please add any comments or info that would help us evaluate your application. Include pertinent volunteer work:
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Attach resume (Word or PDF format):
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