Mo Application Employment Form – Fill Out and Use This PDF

POST HIGH SCHOOL TRAINING (COLLEGE, BUSINESS SCHOOL, MILITARY, ETC.) IF MORE SPACE IS NEEDED, ATTACH ADDITIONAL SHEETS OF PAPER

INDICATE SEMESTER HOURS COLLEGE CREDIT IN THESE AREAS:

			Business		Computer				Political
_____	Accounting	_____	Administration	_____	Science/Information	_____	History	_____	Science	_____	Social Work
_____	Agriculture	_____	Chemistry	_____	Economics	_____	Journalism	_____	Psychology	_____	Sociology
	Biological		Criminal
_____	Sciences	_____	Justice	_____	Education	_____	Mathematics	_____	Recreation	_____	Statistics

COPY OF TRANSCRIPT MUST BE ATTACHED

CERTIFICATES/LICENSES

If you are currently certified, registered, or licensed to practice a profession or occupation, give the following:

COPY OF CERTIFICATE/LICENSE MUST BE ATTACHED

SKILLS

WHAT OFFICE EQUIPMENT CAN YOU OPERATE EFFICIENTLY?

LIST SOFTWARE AT WHICH YOU ARE PROFICIENT

TYPING SPEEDSHORTHAND SPEEDDATE OF LAST TESTNAME OF ADMINISTERING ORGANIZATION

WPM

MO 300-0739 (1-99)

EXPERIENCE RECORD (PAID AND VOLUNTEER)

•List your work experience, starting with the most recent. If you have more than one job with the same organization, list each separately. The information you give 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 may result in your not being qualified or in lower ratings.

•To describe additional experience or add more detail to the “Duties” section, complete a blank sheet of paper using the same format as used here and identify the job to which it relates. A RESUME MAY NOT BE SUBSTITUTED FOR INFORMATION REQUESTED BELOW.

EMPLOYER’S NAME					DUTIES
				SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR		TO: MO/YR
HOURS PER WEEK		LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE			TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?				TOTAL	IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
YES	NO			100%
REASON FOR LEAVING
EMPLOYER’S NAME					DUTIES
				SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR		TO: MO/YR
HOURS PER WEEK		LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE			TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?				TOTAL	IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
YES	NO			100%
REASON FOR LEAVING
EMPLOYER’S NAME					DUTIES
				SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR		TO: MO/YR
HOURS PER WEEK		LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE			TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?				TOTAL	IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
YES	NO			100%

REASON FOR LEAVING

MO 300-0739 (1-99)

EMPLOYER’S NAME					DUTIES
				SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR		TO: MO/YR
HOURS PER WEEK		LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE			TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?				TOTAL	IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
YES	NO			100%
REASON FOR LEAVING
EMPLOYER’S NAME					DUTIES
				SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR		TO: MO/YR
HOURS PER WEEK		LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE			TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?				TOTAL	IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
YES	NO			100%
REASON FOR LEAVING
EMPLOYER’S NAME					DUTIES
				SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR		TO: MO/YR
HOURS PER WEEK		LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE			TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?				TOTAL	IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
YES	NO			100%

REASON FOR LEAVING

Additional space for your experience is available on the back of this form.

MO 300-0739 (1-99)

EMPLOYER’S NAME					DUTIES
				SHOW % OF TIME SPENT ON EACH DUTY IN COLUMN AT LEFT
EMPLOYER’S ADDRESS
KIND OF BUSINESS
YOUR JOB TITLE
FROM: MO/YR		TO: MO/YR
HOURS PER WEEK		LAST MO. SALARY
SUPERVISOR’S NAME AND TITLE			TELEPHONE
MAY WE CONTACT YOUR SUPERVISOR?				TOTAL	IF YOU SUPERVISED EMPLOYEES, PLEASE INDICATE NUMBER AND TYPE OF WORK THEY DID
YES	NO			100%
REASON FOR LEAVING
PERSONAL DATA
A. Have you ever been convicted of a felony?				YES	NO

List all such cases in the “Remarks” section and in each case give: 1. The date, court, and county location;

2. The nature (type) of offense or violation (stealing, burglary, etc.);

3. The penalty imposed (disposition)

Conviction of a violation of the law is not an automatic bar to employment. Each case is considered on its individual merits; however, falsification of the application will result in disqualification. (Suspended execution of a sentence is a conviction.)

B. Are you authorized to work in the U.S.?	YES	NO
C. Are you willing to travel if position requires it?	YES	NO

REMARKS

APPLICANT CERTIFICATION

I hereby certify that this application contains no willful misrepresentation or falsifications and that the information given by me is true and complete to the best of my knowledge and belief. I am aware that should investigation at any time disclose any such misrepresentation or falsification as to a material fact, my application will be rejected, I will be dismissed from the service and, if applicable, my name will be removed from the Merit System register.

SIGNATURE

DATE

AUTHORIZATION FOR RELEASE OF INFORMATION

I hereby authorize my previous employers or any educational institutions I have attended to release to the State of Missouri’s authorized representative any information they may have regarding my character, academic record or employment history, whether on record or not. I also authorize any enforcement agency, or the Department of Revenue or other motor vehicle regulatory agency to allow any authorized representative of the State of Missouri to examine, copy or receive any records pertaining to me regarding convictions or driving record. By authorizing the above, I agree to hold harmless any individual, partnership, corporation, educational institution or agency, its officers, agents and employees from any liability for any damage whatsoever for issuing such information.

SIGNATURE	DATE

MO 300-0739 (1-99)