Mo Application Employment Form – Fill Out and Use This PDF

Your application must be completed in its entirety. Please type or print in ink.

Applications without job titles will be returned.

Check one or more of the following: full-time, part-time, temporary, seasonal.

Check the county or counties in which you are willing to work.

Check highest grade completed: 0-7, 8, 9, 10, 11, 12. College(s) must be accredited by an accrediting agency or association recognized by the U.S. Secretary of Education.

Copy of official transcripts must be attached.

I have a degree, I am working on a degree, I am not working on a degree. Accredited college name and location, credit hours earned, major/minor, degree type, date received, semester hours. Internships and practicums: sponsoring accredited college/university or business, occupational area/field, dates from/to, hours per week, total weeks, college credit and paid, yes or no.

If more space is needed, attach additional pages.

Copy of certificate/license must be attached. If you are currently certified, registered, or licensed to practice a profession or occupation, provide license/certificate issued by, field/trade/specialization, license/certificate number, date of issue, expiration date.

Have you been discharged, asked to resign or resigned in lieu of disciplinary action from any employment? Yes or no. If yes, explain under the appropriate work history in the "Reason for Leaving" field. List your work experience, starting with the most recent. If you have held more than one job or position level with the same organization or state agency, list each as a separate entry.

The information you provide in the "Duties" section is used to determine your qualifications. For those Merit System jobs which require an education and experience rating, this information is the basis for that rating. Incomplete descriptions will impact eligibility determinations and ratings.

You must show the percent of time spent for each job duty. Total 100%. To describe additional experience or add more detail to the duties section, complete and attach a sheet of paper using the same format as used here and identify the job to which it relates. If you supervised employees, please indicate the number and type of work performed. Supervisor contact: yes or no.

A resume may not be substituted for information requested on this form.

Veterans' preference applies to open competitive recruitment, not promotional recruitment. Veterans' preference points are not cumulative and only 5 or 10 points total are allowed.

I am a current resident of Missouri. I have served in the U.S. Armed Forces and separated under honorable conditions, OR I am the spouse of a disabled veteran, OR the unmarried surviving spouse of a person killed while on active duty. (Select from the following options.) I served active duty for at least six (6) consecutive months (unless released early as a result of a service-related disability or a reduction in force at the convenience of the government) OR I was called to active duty by the President and participated in a campaign or expedition for which a campaign badge or service medal has been authorized. (Attach a copy of DD214 showing character of service or award of a badge or medal.) (5 points)

I have satisfactorily completed at least six (6) years of service as a member of the reserves or National Guard. (Attach Point Summary for reserve duty or NGB form 22 for National Guard duty.) (5 points)

I receive compensation for a service-related disability. (Attach a statement from Veterans' Affairs.) OR I am a National Guard veteran who was permanently disabled as a result of active service to the state at the call of the governor. (Attach documentation.) (10 points)

I am the spouse of a disabled veteran who is unqualified for state employment because of a service-related disability. (Attach a statement from Veterans' Affairs that states the percentage and general nature of disability that prohibits your spouse from employment.) (5 points)

I am the unmarried surviving spouse of a disabled veteran OR I am the unmarried surviving spouse of a person who was killed while on active duty in the armed forces of the United States or the National Guard as a result of active service to the state at the call of the governor. (Attach copies of spouse's DD214 or casualty report and Death Certificate.) (5 points)

Parental preference applies to open competitive recruitment, not promotional recruitment. Eligible applicants will be allowed 5 points. I previously left Missouri state government employment to be a full-time homemaker and caretaker of children who were under the age of ten AND I have not been employed for a period of two years. Did you resign in good standing? Yes or no. Missouri state agency you left, your title, and dates of employment. The beginning and ending dates that you were a full-time homemaker and caretaker of children under the age of ten. List any employment during that period. Your full name at the time you left state employment. The name(s) and birth date(s) of the children you cared for during that period.

“I hereby certify that this application contains no known misrepresentation or falsification and that the information given by me is true and complete to the best of my knowledge and belief.”

“I am aware that should an investigation at any time disclose any such misrepresentation as to the material fact, my application will be rejected or if selected, I may be dismissed. By submitting this application and authorizing the above, I hereby agree to hold harmless the State of Missouri, its officers, agents, or employees from any and all liability arising in connection with this application and provided herein, including any damage whatsoever. I will be able to show proof of registration under the United States Military Selective Service act prior to being offered employment with the State of Missouri if am required to register with the selective service.”

For more information on who must register and how to register under the United States Military Selective Service Act, please go to the web site: https://www.sss.gov.

Return to: Division of Personnel Room 430 Truman Building P.O. Box 388 Jefferson City, MO 65102-0388 E-mail Address Persmail@oa.mo.gov Telephone (573) 751-4162 FAX (573) 522-3284 Web Address www.oa.mo.gov/personnel MO 300-0739 (08-17)