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Related Sites

Cochran-Bleckley Industrial Development Authority
Chamber of Commerce
Heart of Georgia Altamaha Regional Commission
Georgia Department of Community Affairs
Georgia Department of Transportation
Bleckley County Government
Bleckley County Sheriff’s Department
Bleckley County Health Department
Georgia House District 144 Representative Danny Mathis
Georgia State Senate District 20 Senator Larry Walker III
Cochran-Bleckley Arts Alliance

Applicant Information
First Name (*)
Last Name (*)
Middle Name
Email Address (*)
Street Address (*)
City (*)
State (*)
Zip Code (*)
Daytime Phone Number (*)
Position Applying To
Position Title (*)
Type of Employment (*)	Full TimePart TimeTemporary
Are you eligible for employment in the U.S.? (*)	YesNo
Have you ever been convicted of a felony? (*)	YesNo
If yes, please explain
Education
High school attended (name and location) (*)
High school dates attended
Graduated high school? (*)	YesNo
College attended (name and location)
College dates attended
Graduated college?	YesNo
Employment History
Current or last employment name (*)
Current or last employment address
Current or last employment from and to dates (*)
May we contact your current or last employer? (*)	YesNo
Current or last employment duties (*)
Current or last employment reason for leaving (*)
Previous employment name
Previous employment address
Previous employment from and to dates
May we contact your previous employer?	YesNo
Previous employment duties
Previous employment reason for leaving
Experience
Computer experience
Skilled trades/years experience
Other experience
Please state any other information that you feel would be helpful to us in considering your application.
References (Please list three)
First Reference Name (*)
First Reference Email Address (*)
First Reference Phone Number (*)
Second Reference Name
Second Reference Email Address
Second Reference Phone Number
Third Reference Name
Third Reference Email Address
Third Reference Phone Number
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PLEASE READ CAREFULLY APPLICANT'S CERTIFICATION AND AGREEMENT
I certify that the information give on this application is true and correct. I understand that any false information, willful or negligent misrepresentation, or failure to disclose any requested information will constitute sufficient grounds for the City to terminate my employment, without notice. I agree to take appropriate employment tests required by the City on the basis of position requirements and I authorize investigation of any and all references and statements made on this application. Additionally, I understand that as a prerequisite for employment, federal law requires that I present document verifying identity and employment eligibility. (*)

Date (*)
Signature/applicant name (*)

Employment Application