Employment Application

Job Position for which you are applying for?(Required)

Name(Required)

First Middle Last

SSN Last 4 Digits Only(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Email(Required)

Cell Phone(Required)

How would you like to be notified?(Required)

Phone

Email

Employment types you will accept(Required)

(Select all that apply)

Permanent Full-Time

Temporary Full-Time (1000 hours per 12-month period)

Other special hiring

Contract

Have you previously applied to the Cabell-Huntington Health Department?(Required)

Yes

No

Have you applied to CHHD using a different full or last name?(Required)

Yes

No

If yes, please enter other name(s):

EDUCATION

Did you receive a high school diploma or GED equivalent?

High School Diploma

GED Equivalent

Neither

Highest Grade Completed(Required)

Please enter a number from 1 to 12.

Additional Education: All academic training other than High School/GED Equivalent may be verified. Verification of academic training can be in the form of an official transcript, copy of diploma or certificate, or written statement from an authorized agency verifying possession of the necessary credentials.

College/University

If you need to list more than one school use the "blue +" on the right hand side to add another row.

School Name

Major/Minor

Credit Hours

Attended (mo./yr - mo./yr)

Type of Degree

Business/Vocational/Technical School

If you need to list more than one school use the "blue +" on the right hand side to add another row.

Course(s) of Study

Weeks Attended

Hours Per Day

Clock Hrs. Completed

Certificate

Additional Training (Seminars, Military Training, Workshops, etc.)

If you need to list more than one training use the "blue +" on the right hand side to add another row.

Course(s) of Study

Weeks Attended

Hours Per Day

Clock Hrs. Completed

Certificate

License(s) (CDL, Nurse, Social Work, etc.)

If you need to list more than one Lincensure use the "blue +" on the right hand side to add another row.

License Number(s)

Exp. Date (MM/YYYY)

Type/Class (Temporary, Class A or B, etc.)

EMPLOYMENT HISTORY

List all work experience beginning with your present/most recent employer. Changes in title, duties, or employment status with the same employer must be listed as separate jobs. Indicate employment dates and hours worked per week. If more space is needed to describe your duties, continue into the next box, or attach additional pages. IMPORTANT: Resumés are to be emailed to Elizabeth Adkins.

Click the 'Add Entry'. button to add Previous/Current Employers