APPLICATION WORD TEMPLATE (2).pdf
PDF 37 KB Posted
- Attached to
- 3374-27-R-RFIN-00002-V01
- Solicitation number
- 3150007001
- Issued by
- Harrison County, Mississippi
About this file
This document is a State of Mississippi application form managed by the Mississippi State Personnel Board (MSPB) for employment opportunities within state government. The application serves as the standard submission document for candidates seeking positions with Mississippi state agencies and is submitted to the MSPB at 210 East Capitol Street, Suite 800, Jackson, MS 39201. Applicants must complete all required sections including personal information, education history, certificates and licenses, and detailed work history spanning multiple positions. The form requires submission of supplemental questions specific to individual job postings, which are available on the MSPB website's Job Openings screen, and applications lacking these supplemental materials or containing insufficient information will be returned as invalid. All applications must be received by the closing date specified in the individual job posting.
The application collects comprehensive employment and qualification information including highest level of education, all college and university attendance with degrees, dates, and graduation status, professional certifications and licenses with issue and expiration dates, and complete work history with employer contact information, supervisor names, salary, and permission to contact previous employers. Applicants must declare their current state employment status, any separations due to reduction in force within the last twelve months, veteran status with required DD214 documentation, disability status if applicable, and selective service registration compliance. The form includes optional demographic questions for reporting purposes only, with the MSPB noting that such information will not be used in employment decisions. All applicants must certify that statements are true and complete and authorize verification by the MSPB; misrepresentation may result in application rejection, removal from the eligible list, or dismissal from state service.
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| SYN_BID_FORM_3150006898.pdf | ||
| download.pdf | ||
| REFERENCE PACKET 7.18.18 (1).pdf | ||
| OT RFI.pdf |
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Text version
Rev 2/2012
STATE OF MISSISSIPPI APPLICATION
Return Completed Application to:
Mississippi State Personnel Board 210 East Capitol Street, Suite 800
Jackson, MS 39201 www.mspb.ms.gov
For Staff/Official Use Only
Received: __________________
Important! Please Read Before you begin the application process:
Applicants must complete and attach the “Supplemental Questions” page when applicable. This page is located on the MSPB website Job Openings screen. Scroll down to the bottom of the screen and click the preferred job; when the description is displayed, click “Print Job Information.” Applications failing to include this page or lacking sufficient information will be returned to the applicant as invalid. Please ensure your application is received by the closing date as indicated on the job posting.
-TYPE OR PRINT IN BLACK INK-
JOB INFORMATION
POSITION #: POSITION TITLE:
PERSONAL INFORMATION
FIRST NAME
MIDDLE INITIAL
LAST NAME
ADDRESS
CITY
STATE
ZIP
HOME PHONE
ALTERNATE PHONE
MONTH AND DATE OF BIRTH
WHICH METHOD DO YOU PREFER TO BE NOTIFIED ABOUT YOUR
APPLICATION STATUS? EMAIL OR PAPER
EMAIL ADDRESS
EDUCATION
WHAT IS YOUR HIGHEST LEVEL OF EDUCATION:
Some High School Some College Associate’s Degree Master’s Degree Doctorate Degree High School Technical College Bachelor’s Degree Specialist’s Degree
HIGH SCHOOL EDUCATION
DID YOU GRADUATE FROM HIGH SCHOOL/RECEIVE A G.E.D.? YES NO
IF NO, WHAT WAS THE HIGHEST GRADE LEVEL COMPLETED? 7 8 9 10 11 12
COLLEGE/UNIVERSITY EDUCATION
SCHOOL NAME
DEGREE RECEIVED
DATES ATTENDED
DID YOU GRADUATE?
YES NO
SEMESTER QUARTER
# OF UNITS COMPLETED:
SCHOOL LOCATION (CITY/STATE)
MAJOR
YES NO
YES NO
Rev 3/2012
CERTIFICATES & LICENSES
TYPE
DATE ISSUED (MONTH/YEAR)
EXPIRATION DATE (MONTH/YEAR)
LICENSE NUMBER
ISSUING AGENCY
SPECIALIZATION
ISSUING AGENCY SPECIALIZATION
WORK HISTORY
DATES
From
To
EMPLOYER
POSITION TITLE
ADDRESS, CITY, STATE
PHONE NUMBER
SUPERVISOR (NAME & TITLE)
HOURS PER WEEK
SALARY
MAY WE CONTACT THIS EMPLOYER?
DUTIES
WORK HISTORY
AGENCY WIDE QUESTIONS
1. ARE YOU CURRENTLY EMPLOYED WITH THE STATE OF MS? YES NO
2. IF YOU ANSWERED “YES” TO THE PREVIOUS QUESTION, INDICATE WHICH AGENCY AND YOUR CURRENT JOB TITLE. (IF YOU PREVIOUSLY INDICATED
“NO”, PROCEED TO THE NEXT QUESTION.)
(AGENCY NAME) (CURRENT JOB TITLE)
3. HAVE YOU BEEN SEPRATED WITHIN THE LAST 12 MONTHS FROM THE STATE OF MS DUE TO A REDUCTION IN FORCE (RIF)? YES NO
4. IF YOU ANSWERED “YES” TO THE PREVIOUS QUESTION, INDICATE WHICH AGENCY, YOUR PREVIOUS JOB TITLE, AND THE DATE OF YOUR RIF
SEPARATION. (IF YOU PREVIOUSLY INDICATED “NO”, PROCEED TO THE NEXT QUESTION.)
(AGENCY NAME) (PREVIOUS JOB TITLE) (DATE OF RIF)
5. ARE YOU A VETERAN OF THE ARMED FORCES? YES NO
(IF YOU INDICATED “YES”, YOU MUST ATTACH A COPY OF YOUR DD214 OR OTHER PROOF OF SERVICES.)
6. IF YOU ARE A VETERAN, WERE YOU DECLARED DISABLED? YES NO
7. ARE YOU AN ADULT MALE BORN ON OR AFTER JANUARY 1, 1960 WHO REGISTERED FOR SELECTIVE SERVICE BETWEEN THE AGES OF 18 AND 25?
TO MEET THE REQUIREMENTS OF FEDERAL REGULATIONS, MSPB NEEDS TO COLLECT INFORMATION ON THE QUESTIONS BELOW FOR REPORTING PURPOSES ONLY. THIS INFORMATION WILL NOT BE USED FOR MAKING EMPLOYMENT DECISIONS. (OPTIONAL)
8. INDICATE YOUR RACE
AMERICAN INDIAN
WHITE
HISPANIC
BLACK
ASIAN
Other
9. INDICATE YOUR GENDER
MALE
FEMALE
10. AGE GROUP:
UNDER 18
18-25 26-39 40-54 55-69 70+
ADDITIONAL INFORMATION
Additional Information (other schools or training; special qualifications; honors and awards; etc.):
APPLICANT DECLARATIONS
By signing this application, I certify that all statements made herein and on any attached documents are true and complete to the best of my knowledge. I authorize the verification of this information by the Mississippi State Personnel Board and any agency considering me for employment. I know that any misrepresentation herein may lead to rejection of my application, removal of my name from the list of eligibles, and/or dismissal from state service. I understand that, as a condition of employment, I will be required to present documentation which verifies both my identity and my employment eligibility pursuant to federal immigration law.
X_________________________________________________________________ _________________________________________________
SIGNATURE OF APPLICANT DATE
SUPPLEMENTAL QUESTIONS
Applicants must complete and attach the “Supplemental Questions” page when applicable. This page is located on the MSPB website Job Openings screen. Scroll down to the bottom of the screen and click the preferred job; when the description is displayed, click “Print Job Information.” Applications failing to include this page or lacking sufficient information will be returned to the applicant as invalid. Please ensure your application is received by the closing date as indicated on the job posting.
ADDITIONAL WORK HISTORY
JOB INFORMATION
JOB NUMBER: POSITION TITLE:
COLLEGE/UNIVERSITY EDUCATION
DATES ATTENDED DID YOU GRADUATE?
CERTIFICATES & LICENSES
WORK HISTORY
ADDRESS
CITY
STATE
COMPANY WEBSITE
HOURS WORKED PER WEEK
MONTHLY SALARY
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