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Employment Application Form

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Bedford County Employment Application Form

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Please correct the field(s) marked in red below:

INSTRUCTIONS: It is important that you fill out all sections of this application completely and to the best of your ability. Your application will be used as part of the certification process and, therefore, should represent your best effort.
As an equal employment opportunity employer, the county assures you that your opportunity for employment will be based on your merit without regard to race, age, color, religion, sex or national origin.
POSITION
POSITION
APPLICANT INFORMATION
APPLICANT INFORMATION

Are you a United States Citizen?

 *
Are you a United States Citizen?

If not, are you legally eligible for employment in the United States?

NOTE: All aliens must provide documents indicating eligibility for employment in the United States required by Virginia Code, Section 40.1-11.1.

 *
If not, are you legally eligible for employment in the United States? NOTE: All aliens must provide documents indicating eligibility for employment in the United States required by Virginia Code, Section 40.1-11.1.
Are you available for full-time work?
Are you available for full-time work?
Will you work overtime if asked?
Will you work overtime if asked?
Have you ever been bonded?
Have you ever been bonded?
EDUCATION
EDUCATION
Highest grade completed.
 *
Highest grade completed.
Are you a high school graduate?
 *
Are you a high school graduate?
Do you possess a high school equivalency certificate (GED)?
 *
Do you possess a high school equivalency certificate (GED)?
COLLEGE OR OTHER TRAINING AFTER HIGH SCHOOL
Name and Address of the COLLEGE OR SCHOOL Attendance From To Major/Specialty Type of Diploma, Degree, License or Certificates earned
1
2
3
4
5
SKILLS
NUMBER OF WORDS PER MINUTE
NUMBER OF WORDS PER MINUTE
DO YOU HAVE A VALID DRIVERS LICENSE?
 *
DO YOU HAVE A VALID DRIVERS LICENSE?
COMPLETE THIS SECTION IF YOU SERVED IN THE U.S. ARMED FORCES
COMPLETE THIS SECTION IF YOU SERVED IN THE U.S. ARMED FORCES
Reserve Status
Reserve Status

EMPLOYMENT HISTORY

INCLUDE MILITARY HISTORY, PART TIME, TEMPORARY, AND SEASONAL EMPLOYMENT.

EMPLOYMENT HISTORY INCLUDE MILITARY HISTORY, PART TIME, TEMPORARY, AND SEASONAL EMPLOYMENT.
Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court?
 *
Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court?
USE THIS SPACE FOR ADDITIONAL OR EXPLANATORY INFORMATION 
THE INFORMATION SUPPLIED BY ME IN THIS APPLICATION IS COMPLETE AND IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT MY MISSTATEMENT OF MATERIAL FACTS WILL CAUSE FORFEITURE OF ALL MY RIGHTS TO ANY EMPLOYMENT OR RESULT IN DISMISSAL FROM EMPLOYMENT, IF HIRED.
 *
THE INFORMATION SUPPLIED BY ME IN THIS APPLICATION IS COMPLETE AND IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT MY MISSTATEMENT OF MATERIAL FACTS WILL CAUSE FORFEITURE OF ALL MY RIGHTS TO ANY EMPLOYMENT OR RESULT IN DISMISSAL FROM EMPLOYMENT, IF HIRED.
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