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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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/UniversityIf you need to list more than one school use the "blue +" on the right hand side to add another row.School NameMajor/MinorCredit HoursAttended (mo./yr - mo./yr)Type of Degree Add RemoveBusiness/Vocational/Technical SchoolIf you need to list more than one school use the "blue +" on the right hand side to add another row.Course(s) of StudyWeeks AttendedHours Per DayClock Hrs. CompletedCertificate Add RemoveAdditional 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 StudyWeeks AttendedHours Per DayClock Hrs. CompletedCertificate Add RemoveLicense(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.) Add RemoveEMPLOYMENT HISTORYList 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 Employer Name Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Signature(Required)Your NameYour NameYour NameYour NameSignature Date(Required) Month Day Year
