Employment – Lee County MS

Personal Information

First & Last Name *

Position Applying For: *

Expected Salary: *

Date of Birth: *

Month

Day

Year

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Email Address *

Phone *

Drivers License No: *

Would you work full time? *YesNo

Specific days and hours you can work: *

Have you ever been employed by Lee County? *YesNo

Do you have any relatives that work for Lee County or have in the past? *YesNo

If your application is considered favorable, when will you be available for work? *

Month

Day

Year

If yes, when, where, and how long did you work for Lee County? *

What was your reason for leaving your previous job with Lee County? *

List your relatives that are or have worked for Lee County and where they are/were employed: *

Military Service Record

Have you ever served in the U.S. Armed Services? *YesNo

Are you currently in the National Guard or Reserve? *YesNo

If yes, what branch? *

If yes, which one? *National GuardReserve

Dates of Duty: From ____ to_____ *

Date of Discharge:

Present Rank: *

Education

College Name: *

Year Graduated: *

What was your major? *

Degree Earned: *

College Name: *

Year Graduated: *

What was your major? *

Degree Earned: *

College Name: *

Year Graduated: *

What was your major? *

Degree Earned: *

College Name: *

Year Graduated: *

What was your major? *

Degree Earned: *

Employment Record

Employer: *

Supervisor: *

Date of employment from _____ to _____: *

Position: *

Salary: *

Duties: *

Reason for Leaving: *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Employer:

Supervisor:

Date of employment from _____ to _____:

Position:

Salary:

Duties:

Reason for Leaving:

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Employer:

Supervisor:

Date of employment from _____ to _____:

Position:

Salary:

Duties:

Reason for Leaving:

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

List any other training or work experience you believe would be helpful for a position here at Lee County.

Have you ever been convicted of a crime? *YesNo( Exclude convictions that have been sealed, expunged or legally eradicated, and misdemeanor convictions for which probation was completed and the case was dismissed?)

If yes, please describe the nature of the crime, date and county of conviction and legal disposition of the case: *

Are you currently out on bail, the subject of a current warrant for arrest or released on your own recognizance pending trial? *YesNo

Personal References

First & Last Name *

Occupation: *

Phone: *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

First & Last Name *

Occupation: *

Phone: *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

First & Last Name *

Occupation: *

Phone: *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

This application is valid for six(6) months only.

If after the expiration of six(6) months you have not been hired and still desire employment, it will be necessary for you to re-apply.

Date: *

Signature of the Applicant: *

Interested in joining us?

Rather print & fill out the form?

Personal Information

Military Service Record

Education

Employment Record

Personal References

This application is valid for six(6) months only.

If after the expiration of six(6) months you have not been hired and still desire employment, it will be necessary for you to re-apply.

Contact the Board of Supervisors

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Get social

Contact the Board
of Supervisors

quick links

Get social

Interested in joining us?

Rather print & fill out the form?

Personal Information

Military Service Record

Education

Employment Record

Personal References

This application is valid for six(6) months only.

If after the expiration of six(6) months you have not been hired and still desire employment, it will be necessary for you to re-apply.

Contact the Board of Supervisors

quick links

Get social

Contact the Boardof Supervisors

quick links

Get social

Contact the Board
of Supervisors