Maryland Employment Application Form – Fill Out and Use This PDF

www.workformaryland.com

Do not fill this out if you have access to the internet! We have our application process online. Complete one application, apply for multiple jobs. Find out the status of your application 24 hrs a day, 7 days a week!! Receive email notifications of new job openings through our online interest file. An email address is all you need. Free email accounts are available from various providers. Don’t have a computer? Public libraries offer free access to computers or visit our State Employment Center at 301 W. Preston Street, Room 510A, Baltimore, 21201.

You are required to provide the following information:

First 3 Letters of Last Name at Birth: _______Birth Month: ___________Birth Day: _____Last 4 digits of SSN ______

Personal and Contact Information

Job Number: ______-_________-________ Job Title: _____________________________________

Name: _______________________________	______________________________	___________
Last	First	Middle

Address: __________________________________________________________________________

Number, Street and Apt.

City: _____________________ County: _________________ State: ___________ Zip: ___________

Phone: __________________________ __________________________ ______________________

PrimaryOk to leave msg? WorkOk to leave msg? Alternate Ok to leave msg?

Email Address: _____________________________________________________________________

How did you hear about this job opening? ________________________________________________

Employment Preference

Never been employed by the State of Maryland Current employee of the State of Maryland

Former employee who has held employment with the State of Maryland in the past three years. Former employee whose most recent employment with the State of Maryland was over three years ago

If a current/former employee of the State of Maryland, provide the following information at time of separation:

______________________________	________________________________________
First Name	Last Name

_________ (Provide the initial that is/was in employee record to ensure that appropriate extra points are awarded) _________

Middle Initial

Birth Year

Do you have a valid Driver’s license?

Yes

No (For positions requiring a driver’s license, please attach a copy

of your license or write on a separate sheet of paper your driver’s license number, class, state of issuance and expiration date.)

STATE OF MARYLAND – AN EQUAL OPPORTUNITY EMPLOYER

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Voluntary Equal Opportunity Information

To further its commitment to equal opportunity employment, the State of Maryland requests applicants to VOLUNTARILY provide the following information. This information will be used for statistical purposes only by authorized personnel.

Origins in any of the original peoples of the Far East, Southeast Asia, or the India subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

Black or African American

Origins in any of the black racial groups of Africa

American Indian or Alaska Native

Origins in any of the original peoples of North or South American, including Central America, and who maintains tribal affiliations or community attachment.

Pacific Islander or native Hawaiian

Origins in the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White

Origins in any of the original peoples of Europe, the Middle East, or North Africa

Veteran’s Information:

A copy (not original) of your proof eligibility DD-214 for Veterans Credit must be submitted and completely verified before Veterans Credit will be approved. Proof will only need to be submitted once. Regular State employees do not need to submit proof of eligibility for Veterans Credit. If Yes, you must also submit DD Form 214.

If you answered Yes to seeking veteran’s preference, select ONE of the following that best describes your situation:

Are you fluent in a language other than English? (if required for the job for which you are applying)

Yes	No If yes, please list: _____________________________________________

STATE OF MARYLAND – AN EQUAL OPPORTUNITY EMPLOYER

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Education and Training

Dates attended: _______ - _________ Major course of study: ______________________________

From To

College and Graduate School Education

Specialized Training or Classes Relevant to the Job

Please submit a copy of any relevant professional or trade licenses or certificates with this application.

Work Experience

List below, beginning with your most recent position, all of your work experience, including military service and all volunteer activities. Attach additional 8 1/2" x 11” sheets of paper if necessary. If your title and duties changed in the course of your service in any one organization, indicate such changes clearly and as separate employment. Please do not submit a resume in lieu of completing this portion of the application. Be sure that the information included in this section demonstrates that you meet the experience qualifications for the job for which you are applying.

Job Number 1: (Current or Most Recent)

Name of Employer:	Employer’s Address (Street, City, State, Zip Code):
Type of Business:	Supervisor’s Name, Title and Phone Number:
Your Job Title:	Do you supervise other employees?		Job Titles of Those You Supervise:
	Yes No How many?
Dates of Employment (From: Month/Day/Year To: Month/Day/Year):	Is your position considered full-time?	Yes No
	How many hours do you work per week?
Job Dutes:
Reason For Leaving:

STATE OF MARYLAND – AN EQUAL OPPORTUNITY EMPLOYER

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Work Experience - Continued

Job Number 2:

Name of Employer:		Employer’s Address (Street, City, State, Zip Code):
Type of Business:		Supervisor’s Name, Title and Phone Number:
Your Job Title:		Do you supervise other employees?					Job Titles of Those You Supervise:
		Yes		No	How many?
Dates of Employment (From: Month/Day/Year To: Month/Day/Year):		Is your position considered full-time? Yes							No
		How many hours do you work per week?
Job Duties:
Reason For Leaving:
Job Number 3
Name of Employer:			Employer’s Address (Street, City, State, Zip Code):
Type of Business:			Supervisor’s Name, Title and Phone Number:
Your Job Title:			Do you supervise other employees?						Job Titles of Those You Supervise:
			Yes	No	How many?
Dates of Employment (From: Month/Day/Year To: Month/Day/Year):			Is your position considered full-time?			Yes			No
			How many hours do you work per week?
Job Duties:
Reason For Leaving:
Job Number 4:
Name of Employer:			Employer’s Address (Street, City, State, Zip Code):
Type of Business:			Supervisor’s Name, Title and Phone Number:
Your Job Title:			Do you supervise other employees?						Job Titles of Those You Supervise:
			Yes	No	How many?
Dates of Employment (From: Month/Day/Year To: Month/Day/Year):			Is your position considered full-time?			Yes			No
			How many hours do you work per week?
Job Duties:
Reason For Leaving:

STATE OF MARYLAND – AN EQUAL OPPORTUNITY EMPLOYER

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Locations

In which counties will you accept employment?

YOU MAY BE TESTED FOR ILLEGAL DRUG USE. IF SELECTED FOR A POSITION IN THE SKILLED OR PROFESSIONAL SERVICE, YOU MAY BE GIVEN A MEDICAL EXAMINATION TO DETERMINE YOUR ABILITY TO PERFORM JOB-RELATED FUNCTIONS.

Have you ever been convicted of any violation of law other than a minor traffic violation? Yes

No

If yes, give the

date, place of conviction, charge and disposition of each case. Note: A conviction record will not necessarily bar you from employment. (Please write this information on a separate sheet of paper and attach it to this application.)

“UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.”

This provision does not apply to applicants for law enforcement positions pursuant to Labor and Employment Article, Section 3-702 (b) Annotated Code of Maryland.

____________________	____________________________________________________
DATE	SIGNATURE OF APPLICANT

STATE OF MARYLAND – AN EQUAL OPPORTUNITY EMPLOYER

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