APPLICATION LAURENS COUNTY HUMAN RESOURCES POBOX445 FOR EMPLOYMENT LAURENS, SOUTH CAROLINA 29360 (864) 984-3691 We consider applicants r all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status. Position (s) Applied For How Did You Le About Us? D Advertisement D Employment Agency Last Name Address Number Street Telephone Number(s) D D (PLEASE PRINT) Friend Relative First Name City D D Do you have a valid S.C. Driver's License? If yes, list License Walk-In Other Number List Driver's License Classification ______ _ Have you ever filed an application with us bere? State If Yes, give date Have you ever been employed with us bere? Are you currently employed? May we contact your present employer? Are you prevented om lawlly becoming employed in this country because of Visa or Immigration Status? Proof ofcitizenship or immigtion status will be required upon employment. On what date would you be available r work? Are you available to work: DFull Time DPart Time IfYes, give date DShift Work Are you currently on "lay-off' status and subject to recall? Can you travel if a job requires it? Date of Application Middle Name Zip Code Last four of Social Security Number DYES ONO DYES DYES DYES DYES DYES OTemporary DYES DYES ONO ONO ONO ONO ONO ONO ONO Have you ever been convicted of, or pled guilty, or no contest to, any crime other than a minor traffic violation? YES NO