Employment Application | Lincoln County New Mexico

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity, or any other legally protected class. Lincoln County participates with E-Verify. If you are hired for any position, federal law requires that you provide proof of your eligibility to work in the United States within 72 hours of your hire date. Failure to prove such eligibility will void the offer of employment.

Position Applied For:*

Date of Application*

How did you hear about us?

Name*

First Middle Last

Name must match the name on your social security card.

Last 4 Digits of your SSN*

Email

Home Phone

Mobile Phone

If you are under 18 years of age, can you provide required proof of your eligibility to work?*

Yes
No

If yes, give date

Have you ever been employed with us before?*

Yes
No

If yes, give date

Are you Currently Employed?*

Yes
No

If yes, may we contact your present employer?

Yes
No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*

Yes
No

Proof of citizenship or immigration stats will be required upon employment

Are you available to work:*

Full Time
Part Time
Shift Work
Temporary

Are you currently on "lay-off" status and subject to recall?*

Yes
No

Can you travel if a job requires it?*

Yes
No

Have you been convicted of a felony within the last 5 years?*

Yes
No

(A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question)

If yes, please explain

Education

HIGH SCHOOL

High School Name

High School Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Course of Study

Years Completed

Diploma/Degree

UNDERGRADUATE COLLEGE

Under Graduate College Name

Under Graduate College Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Course of Study

Years Completed

Diploma/Degree

GRADUATE / PROFESSIONAL

Graduate / Professional Name

Graduate / Professional Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Course of Study

Years Completed

Degree

OTHER

Do you have another education institution to enter?

Yes
No

Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Course of Study

Years Completed

Diploma/Degree

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any honors you have received

State any additional information you feel may be helpful to us in considering your application

Foreign Languages

Indicate any foreign languages you can speak, read and/or write.

Foreign Languages

Language Name	Actions
	Edit Delete
There are no Languages.

Maximum number of languages reached.

Click the "Add Language" button to get started.

Additional Activities

List professional, trade, business or civic activities and offices held.

You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status. Click the + sign to add additional items

Have you ever had any job-related training in the United States Military?

Yes
No

If yes, please describe.

Are you physically or otherwise unable to perform the duties of the job for which you are applying?

Yes
No

References

Give the name, address and telephone number of three references who are not related to you and are not previous employers. Click the "Add Reference" button to get started

References

Reference Name	Reference Phone	Actions
		Edit Delete
There are no References.

Maximum number of references reached.

Work Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status. Click the "Add Work Experience" button to get started

Work Experience

Employer Name	Job Title	Actions
		Edit Delete
There are no Work Experience.

Maximum number of work experience reached.

Include any explanation of any gaps in employment

Summarize special job-related skills and qualifications acquired from employment or other experience

Release of Information Waiver

Authorization for Release of Information*

I certify that answers given heroine are true and complete to the best of my knowledge.

As a condition for new employment, it is required that the applicant consent to and authorize a verification of background information submitted and their application and/or resume.

The signing of this instrument acknowledges a reading and understanding of this instrument. It acknowledges that it is authorizing the release of information from persons, schools, current and former employers, and other organizations and agencies to the County of Lincoln with all information requested except as prohibited by law. The signing of this instrument further releases all of the person and entities providing information from any and all claims and damages connected with their release of any requested information. It is further authorized by applicant that a copy of this instrument may suffice for the original. Further, applicant by his or her signature agrees to forever release and discharge the Count of Lincoln and its agents, employees, and servants to the full extent permitted by law from any claims, damages, losses liabilities, costs or expenses, or other charge or complain which may be filed or brought arising from the retrieving and reporting of information.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

The applicant understands that neither this document nor any offer of employment from the employer constitute an employment contract unless a specific document to that affect is executed by the employer and employee in writing.

In the event of employment, I understand that false or misleading information given by my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

The County requires the application selected to fill a vacant position to take an employment physical examination to determine whether the employee can perform the essential functions of the position. The physical examination will include a substance abuse test. If the employee does not successfully complete the physical examination and the substance abuse test, it will result in immediate withdrawal of the offer of employment.

I agree to the Authorization for Release of Information

Name

First Last

Date of Birth

Social Security #

Phone

Drivers License #

Driver's License State

State

Address

Street Address Address Line 2 City State ZIP Code

Place of Birth

City State

Other Names Used

Signature

Please enter your full name in the signature field. By entering your name, you hereby verify that all corresponding information is accurate to the best of your knowledge

Date

Americans with Disabilities Act

In conformation with the Americans with Disabilities Act, I acknowledge by my signature that should I be offered a position, contingent upon satisfactory background investigation, worker's compensation information obtained from the Department of Labor and/or the Worker's Compensation Commission is hereby authorized. All results will be proprietary and will be kept confidential. The information provided will not be provided to any parties other than to designated County personelle

Signature

Please enter your full name in the signature field. By entering your name, you hereby verify that all corresponding information is accurate to the best of your knowledge

County of Lincoln Veteran's Certification Form for Job Application

Applicant's Name

First Last

Pursuant to Count of Lincoln Resolution 2014-35, the Count of Lincoln Human Resources/Recruitment Office has implemented a Veteran's Hiring Initiative policy. When a veteran applicant meets or exceeds the minimum qualifications on a job posting, and has completed and passed any testing procedures required by the department for employment qualification, the applicant shall be identified by the Human Resources/Recruitment Office on the list of eligible applicants for the department seeking to fill a position that the applicant is a "veteran". The purpose of this form is to allow job applicants the opportunity to identify and certify that they are a veteran who has an honorable discharge from the military or to verify that the job applicant is a member of the National Guard or Reserve who has successfully completed basic training. Once verified and/or certified as a veteran AND if it is determined that the veteran applicant meets or exceeds the minimum qualifications on a job posting, the Human Resources/Recruitment Office will identify the veteran applicant on the list of eligible applicants for the department seeking to fill the position. Once certified and identified by the Human Resources/Recruitment Office, the department shall interview the identified veteran. In further accordance with the County of Lincoln Resolution 2014-35, the Governing Body does not guarantee that a veteran shall be hired for the position being applied for, only that the veteran will be given an interview To identify yourself as a veteran or a member of the National Guard or Reserve who has successfully completed basic training, answer the following questions:

Have you ever served in the United Military on Active, Guard or Reserve Status?

Yes
No

Did you receive an honorable discharge?

Yes
No

Are you a member of the National Guard or Reserve who has successfully completed basic training

Yes
No

To certify your veteran status, please attach a copy of your "DD214" or "DD215" form, and/or proof of current Active, Guard, or Reserve enlistment.

Please ensure your application clearly indicates your military experience and identify any education, job duties and/or responsibilities.

Signature

Please enter your full name in the signature field. By entering your name, you hereby verify that all corresponding information is accurate to the best of your knowledge

Date