Form Center

Step One

Grant County makes its employment decisions without regard to race, color, gender, national origin, sex, retaliation, religion, marital status, age, association with protected classes, sexual orientation, gender identity, prior industrial injury, mental or physical disabilities unrelated to job performance, veterans, or any other protected class under federal or state law.

Grant County is a Drug-Free Workplace and complies with the Oregon Smoke-Free Workplace law. Candidates who are provided a conditional offer of employment will be subject to a criminal history records check. Those candidates who will be in a safety sensitive position will be subject to a pre-employment drug test. Those candidates who will be required to hold a driver’s license will be subject to a pre-employment DMV records check to ensure a safe driving record.
Important Note
This application will be considered only for this specific job. It will not be retained for future positions. If you desire to be considered for a position at a future time, you must file a new application. If hired, this application will become part of your permanent personnel file.
1. Position Applied For
Date
Date
2. Full Name
Last Name
First Name
Middle Initial
3. Address
Mailing Address
City
State
Zip
4. Phone Numbers
Home Phone
Work Phone
If permission to contact you at work.
Other Phone
5. Confidential Email
An email address where information regarding this application may be sent.
6. How did you hear about this opportunity?
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13. References
List three professional references, other than family, who are familiar with your work experience and job performance.
Reference One
Reference Name
Reference Occupation
Reference Address
City
State
Zip
Reference Phone
Reference Email
Your Relationship to Reference
Reference Two
Reference Name
Reference Occupation
Reference Address
City
State
Zip
Reference Phone
Reference Email
Your Relationship to Reference
Reference Three
Reference Name
Reference Occupation
Reference Address
City
State
Zip
Reference Phone
Reference Email
Your Relationship to Reference
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Other Important Information
14. Immigration & Reform Act & Control Act of 1986
If hired, you will be required to submit identification in accordance with the Immigration and Naturalization Service requirements.
Do you have the legal right to work in the U.S.?
1. Yes
2. No
15. Ability to Perform the Essential Job Functions
A job description detailing the essential functions and duties of the job for which you are applying is attached.
Are you able to perform the essential job functions or duties listed with or without accommodation?
1. Yes
2. No
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Application Understanding & Agreement
As an applicant for employment with Grant County, I understand and authorize the following:
I hereby certify that the information contained in this application contains no misrepresentations or falsifications, and that the information given is true and complete to the best of my knowledge and belief. I fully understand that misrepresentations or an omission of fact in this application is cause for disqualification of this application and/or dismissal from employment. I fully understand the requirements for employment with Grant County as contained in this application.

I authorize Grant County, OR, to make any and all necessary inquiries or investigations to verify or supplement the information contained herein. I also specifically authorize any past employer, education, or other person with knowledge of my work history, to release to Grant County, any information requested to determine my qualifications and fitness for the position I am seeking.

Further, I release Grant County and all individuals giving or receiving information from any liability or damage whatsoever which may result from furnishing the requested information. An unsigned application is considered an incomplete application.
1. I agree
Digital Signature of Applicant
Date
Date
Important Note
An incomplete application will not be accepted. Complete the attached Veterans’ Preference form if applicable.
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