Employment Opportunities in Philippi, Junior, and Belington, WV
Serving All of Barbour County

Click here to download the PDF version of our Employment Application.

Step 1 of 11

Date*
Date Format: MM slash DD slash YYYY
Name*
First Middle Last
Present Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How long at current address?*
Email*
Phone*
Best time to contact you?*
Are you under age 18?*
- Yes
- No
Can you provide proof of your eligibility to work?*
- Yes
- No
Position Applied for*
Times available to work Sunday
Times available to work Monday
Times available to work Tuesday
Times available to work Wednesday
Times available to work Thursday
Times available to work Friday
Times available to work Saturday
Requested Wage or Salary*
How many hours can you work weekly?*
Employment Desired*
- Full-Time Only
- Part-Time Only
- Full-Time or Part-Time
When are you available to start work?
Date Format: MM slash DD slash YYYY

High School Education
Name of school
Location
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of years completed
Major & Degree
College Education
Name of school
Location
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of years completed
Major & Degree
Graduate/Other Education
Name of school
Location
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of years completed
Major & Degree

Have you ever been convicted of a crime?*
- Yes
- No
A conviction record will not necessarily disqualify you from employment, but a less than full and complete response can result in termination.
For each conviction, please state the nature of the crime, the date of conviction, the jurisdiction in which you were prosecuted, the sentence imposed (including probation) and any additional explanation you wish to provide.*

What is your means of transportation to work?*
Do you have a driver's license?*
- Yes
- No
Driver's License #*
Driver's License State of Issue*
Type of Driver's License*
- Operator
- Commercial (CDL)
- Chauffeur
Driver's License Expiration Date*
Date Format: MM slash DD slash YYYY
Have you had any accidents during the past three years?*
- Yes
- No
How many accidents have you had during the past three years?*
Have you had any moving violations during the past three years?*
- Yes
- No
How many moving violations have you had during the past three years?*

References
Please list two references other than relatives.
Reference #1 Name*
First Last
Reference #1 Position*
Reference #1 Company*
Reference #1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #1 Phone*
Reference #2 Name*
First Last
Reference #2 Position*
Reference #2 Company*
Reference #2 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #2 Phone*

Please use this space to elaborate on any background, experience or qualification that you believe should be considered in evaluating your application for employment. You may include hobbies, volunteer experience and any other activities you believe relevant. Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, any disability, religious or political affiliations.

Military
Have you ever been in the armed forces?*
- Yes
- No
Are you now a member of the National Guard?*
- Yes
- No
Military Specialty
Military Date Entered
Date Format: MM slash DD slash YYYY
Military Discharge Date
Date Format: MM slash DD slash YYYY

Employment History
May we contact your present employer?*
- Yes
- No
Employment History #1
Name of Employer #1
Address of Employer #1
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone of Employer #1
Name of Last Supervisor, Employer #1
Employment Dates, Employer #1
Pay or Salary (Start & Final), Employer #1
Last Job Title, Employer #1
Reason for Leaving (be specific), Employer #1
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at Employer #1.
Employment History #2
Name of Employer #2
Address of Employer #2
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone of Employer #2
Name of Last Supervisor, Employer #2
Employment Dates, Employer #2
Pay or Salary (Start & Final), Employer #2
Last Job Title, Employer #2
Reason for Leaving (be specific), Employer #2
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at Employer #2.
Employment History #3
Name of Employer #3
Address of Employer #3
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone of Employer #3
Name of Last Supervisor, Employer #3
Employment Dates, Employer #3
Pay or Salary (Start & Final), Employer #3
Last Job Title, Employer #3
Reason for Leaving (be specific), Employer #3
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at Employer #3.
Employment History #4
Name of Employer #4
Address of Employer #4
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone of Employer #4
Name of Last Supervisor, Employer #4
Employment Dates, Employer #4
Pay or Salary (Start & Final), Employer #4
Last Job Title, Employer #4
Reason for Leaving (be specific), Employer #4
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at Employer #4.

DO NOT ANSWER THESE QUESTIONS UNLESS YOU HAVE RECEIVED A JOB DESCRIPTION OF THE POSITION THAT INFORMS YOU ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonble manner, with or without a resonable accommodation, the esential functions of the job for which you have applied?
- Yes
- No
A review of the essential functions has been provided to me.
- Yes
- No

Application Form Waiver
As indication that you have read and understood each section, please provide your signature in the spaces provided below.
I agree that:

Neither the acceptance of this application nor the subsequent entry into any type if employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements and the like as they may exist from time to time, or other County practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of the County, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument approved by the Barbour County Commission with authorization for the President of the Barbour County Commission to affix their signature. The undersigned and County may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the County may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.
Signature*
Date*
Date Format: MM slash DD slash YYYY
I authorize investigation of all statements contained in my application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the County permission to contact schools, previous employers (unless otherwise indicated), references and others and do hereby release the County from any liability as a result of such contact.
Signature*
Date*
Date Format: MM slash DD slash YYYY
I understand that, in connection with the routine processing of my employment application, the County may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics and mode of living. Upon written request from me, the County will provide me with additional information concerning the nature and scope if any such report requested by it, as required by the Fair Credit Reporting Act.
Signature*
Date*
Date Format: MM slash DD slash YYYY
I understand that, in connection with the routine processing of my employment application, the County may request or conduct a criminal background request or investigation so as to ascertain whether I have been convicted of a crime. In addition, I understand that such convictions, if any, will not necessarily disqualify my employment with the County. However, less than a full and complete response can result in termination.
Signature*
Date*
Date Format: MM slash DD slash YYYY
The County Commission of Barbour County, West Virginia, is an equal employment opportunity employer and adheres to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability. The opportunity for employment with Barbour County depends solely on your qualifications. Barbour County has established a drug free and tobacco free work environment.

Barbour County Commission
Employment

Employment Opportunities in Philippi, Junior, and Belington, WV
Serving All of Barbour County

Step 1 of 11

High School Education

College Education

Graduate/Other Education

Computer Skills

References

Military

Employment History

Employment History #1

Employment History #2

Employment History #3

Employment History #4

DO NOT ANSWER THESE QUESTIONS UNLESS YOU HAVE RECEIVED A JOB DESCRIPTION OF THE POSITION THAT INFORMS YOU ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Application Form Waiver

Barbour County Commission Employment

Employment Opportunities in Philippi, Junior, and Belington, WV Serving All of Barbour County

Step 1 of 11

High School Education

College Education

Graduate/Other Education

Computer Skills

References

Military

Employment History

Employment History #1

Employment History #2

Employment History #3

Employment History #4

DO NOT ANSWER THESE QUESTIONS UNLESS YOU HAVE RECEIVED A JOB DESCRIPTION OF THE POSITION THAT INFORMS YOU ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Application Form Waiver

Barbour County Commission
Employment

Employment Opportunities in Philippi, Junior, and Belington, WV
Serving All of Barbour County