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(270) 451 – 5020
Fax:
(270) 451 – 5025
info@southstate.us
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Employment Application
1
Information
2
Education
3
Employment
4
References
5
Submit
Applicant Information
Position Applied For
*
Full Name
*
First
Middle
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
Desired Salary
*
Date Available
*
MM slash DD slash YYYY
Are you a citizen of the United States?
*
Yes
No
If NO, are you authorized to work in the United States?
*
Yes
No
Have you ever worked for South State Contractors?
*
Yes
No
If YES, when did you work for SSC?
*
Have you ever been convicted of a felony?
*
Yes
No
If YES, please explain:
*
Education
High School
Address
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Did you Graduate?
Yes
No
Diploma
College
Address
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Did you Graduate?
Yes
No
Degree
Other
Address
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Did you Graduate?
Yes
No
Degree
Employment History
Employer One
Phone
Address
Job Title
Supervisor
Starting Salary
Ending Salary
Responsibilties
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for Leaving
May we contact your past or present supervisor for a reference?
Yes
No
Employer Two
Phone
Address
Job Title
Supervisor
Starting Salary
Ending Salary
Responsibilties
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for Leaving
May we contact your past or present supervisor for a reference?
Yes
No
Employer Three
Phone
Address
Job Title
Supervisor
Starting Salary
Ending Salary
Responsibilties
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for Leaving
May we contact your past or present supervisor for a reference?
Yes
No
Employer Four
Phone
Address
Job Title
Supervisor
Starting Salary
Ending Salary
Responsibilties
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for Leaving
May we contact your past or present supervisor for a reference?
Yes
No
References
Reference One Name
First
Middle
Last
Company
Relationship
Phone
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Reference Two Name
First
Middle
Last
Company
Relationship
Phone
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Reference Three Name
First
Middle
Last
Company
Relationship
Phone
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Military Service
Service Branch
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Rank at Discharge
Submission Agreement
CAPTCHA
Terms and Conditions
*
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
I have read and agree to the terms.
Δ