APPLICATION FOR EMPLOYMENT
RICHLAND COUNTY GOVERNMENT Human Resources Department
2020 Hampton Street, Room 3058 Columbia, SC 29204 Ph: 803-576-2110 – Fax: 803-576-2119 - Employment Website – www.rcgov.us

DATE: ____________________________ POSITION APPLIED FOR: ______________________________________________________________
ONLY ONE POSITION PER APPLICATION INSTRUCTIONS TO APPLICANT: Please type or print legibly in ink all information except signature. Incomplete applications will not be accepted. Applications must have all sections completed and the form signed by the applicant. An application must be completed for each vacancy. A résumé may be attached but not substituted for completing the application. All qualified applications will be referred to the department where the vacancy is located. That Department Head is responsible for the review and evaluation of applications and recommending the most qualified applicants to be selected for an interview. Applications will remain active until the vacancy is filled. If you wish to remain informed of positions available at Richland County, please visit our website at www.rcgov.us. Thank you for your interest in Richland County Government.

PERSONAL DATA
NAME (Last, First, MI): SOCIAL SECURITY NUMBER: MAILING ADDRESS: CITY: HOME PHONE #: STATE: WORK PHONE #: ZIP CODE: COUNTY NUMBER: MAY WE CALL YOU AT WORK: YES _____ NO _______ DATE OF APPLICATION:

ARE YOU LEGALLY AUTHORIZED TO WORK IN THE UNITED STATES?

DO YOU HAVE RELATIVES EMPLOYED BY RICHLAND COUNTY? YES ______ NO _______ IF SO, NAME(S) /RELATION _____________________________________________________________________________ WHAT DEPARTMENT __________________________________________________________________________________

DO YOU POSSESS A VALID DRIVERS LICENSE?

YES

NO

NUMBER

EXP. DATE

HAVE YOU BEEN CONVICTED OR PLED NO CONTEST OF A CRIME