Application for Employment Step 1 of 5 20% Your Personal InformationYour Name(Required) First Last Your Email Address(Required) Enter Email Confirm Email Home Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Is your home address the same as your mailing address?(Required) Yes No Mailing Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Best Time To Call YouMorningsEarly AfternoonLate AfternoonEarly EveningAre you legally authorized to work in the US?(Required) Yes No Are you at least 21 years of age?(Required) Yes No Driver's License #(Required) State(Required) Do you have a CDL? Yes No Employment InformationPosition Applied For Store Staff Warehouse Staff Office Staff Any Are you seeking…? Part Time Full Time Seasonal / Temporary Anything Available Have you ever been employed with Wayne County ABC before?(Required) Yes No Have you ever applied with Wayne County ABC before?(Required) Yes No Are you related in any way to any person currently employed with Wayne County ABC?(Required) Yes No Please give name and relationship of current relative employed with Wayne County ABC If offered a position, when would you be able to start?(Required) Education InformationHighest Level of Education Completed(Required) High School GED College Graduate School High SchoolPlease provide name and address for your high school, as well as whether or not you graduated and what year.Vocational/TechnicalIf you attended a vocational or technical school, please provide the name and address, as well as any degree or certification you received there along with the year.CollegeIf you attended college, please provide the name and address of the college, as well as your major and year of graduation (if applicable).Graduate SchoolIf you attended graduate school, please provide the name and address of the school, as well as your field of study and date of graduation (if applicable). Employment HistoryAnswer the questions for each period of employment. Include any military service. Begin with your present or latest employment and use additional sheets in the same format if necessary. Be sure to account for gaps in your employment history. “See attached resume” is NOT ACCEPTABLE.May we contact anyone listed below?(Required) Yes No Maybe (explain below) Please explain the "Maybe" on the question above Employer or Company Name (1) Employer Address (1) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Supervisor's Name (1) Supervisor's Title (1) Supervisor's Phone (1)Supervisor's Email (1) Starting and Ending Dates of Employment (1) Brief Description of Job Responsibilities (1)Brief Description of Reason for Leaving (1)Employer or Company Name (2) Employer Address (2) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Supervisor's Name (2) Supervisor's Title (2) Supervisor's Phone (2)Supervisor's Email (2) Starting and Ending Dates of Employment (2) Brief Description of Job Responsibilities (2)Brief Description of Reason for Leaving (2)Employer or Company Name (3) Employer Address (3) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Supervisor's Name (3) Supervisor's Title (3) Supervisor's Phone (3)Supervisor's Email (3) Starting and Ending Dates of Employment (3) Brief Description of Job Responsibilities (3)Brief Description of Reason for Leaving (3) Reference InformationIn listing references, submit persons who are not related to you and who have knowledge of your qualifications for the position of which you are applying. Examples would be former supervisors, co-workers, teachers, etc. Do not include supervisors listed already within the previous section, Employment History.Reference 1(Required)NamePhoneEmail AddressRelationshipReference 2(Required)NamePhoneEmail AddressRelationshipReference 3(Required)NamePhoneEmail AddressRelationshipUpload ResumeAccepted file types: doc, docx, pdf, Max. file size: 2 MB.Authorization(Required)– I certify that, to the best of my knowledge, the statements and information listed are true and complete. – I understand that misrepresented, falsified, or omitted information may disqualify me for employment consideration or result in dismissal from employment with Wayne County ABC. – I hereby understand and acknowledge that unless otherwise defined by applicable law, any employment relationship with Wayne ABC is of an “at will” employment. It is further understood that this “at will” employment relationship may not be changed by any written document unless such change is specifically approved by the Wayne County ABC Board. – I hereby understand that I am required to abide by all rules and regulations of the Wayne County ABC. – I authorize Wayne CountyABC to collect from me any specimen required for drug screening as pre-employment consideration. – Wayne County ABC may obtain information about me from a consumer reporting agency for employment purposes. Thus, I may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about my character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as my neighbors, friends or associates. These reports may contain information regarding my criminal history, credit history, motor vehicle records (“driving records”), verification of my education or employment history or other background checks. I have read and agree to all of the above.Social Security Number(Required) E-Signature – Type your full name below(Required)By typing your name in this box and submitting this form, you are attesting to all of the information you have provided in this Application of Employment.