If you or anyone you know is interested in this position, please forward this to them or have them apply through the www.careers.ga.gov website. *** THE STATE PERSONNEL OFFICE ANNOUNCES THE FOLLOWING AVAILABLE VACANT POSITION: HVAC REPAIR TECHNICIAN at the Georgia Garrison Training Center at Fort Stewart, Georgia. To view the announcement details, click on this link: https://www.careers.ga.gov/jobsearch/jobdetail.asp?ReqNum=411-30801

1. STATE OF GEORGIA
APPLICATION FOR EMPLOYMENT
Georgia Department of Defense version
An Equal Opportunity Employer and Drug-Free Workplace
ANNOUNCEMENT JOB TITLE ANNOUNCEMENT NUMBER
PERSONAL INFORMATION:
Last Name First Name Middle Initials
Street or Mailing Address Apartment No.
City State Zip Code County
Contact Phone Numbers (s) Email address
Cell: Home:
EMPLOYMENT ELIGIBILITY: To be employed by the State of Georgia and the Georgia Department of Defense, you must meet certain
State and Federal employment eligibility requirements. These include (but are not limited to) United States citizenship or authorization to work in this
country, positive rehire status if previously employed by the State, and no felony convictions (for some jobs). Please answer the following questions.
1. Are you a United States 2. Are you an alien authorized to work in 3. Have you ever been dismissed from any 4. Have you ever been convicted
citizen? the United States? State of Georgia government position? of a felony?
N/A YES NO YES NO YES NO
YES NO If YES, attach an explanation. If YES, attach an explanation.
EDUCATION:
High School Graduate or Vocational/Business School: No. of Field of Study: Completed: Yes No
Equivalent (GED)? Months: Date:
Yes No (Mo/Yr)
TYPE OF DATE
CREDIT
PLEASE LIST EXACT COLLEGE HOURS : DEGREE DEGREE
RECEIVED FIELD/AREA OF CONCENTRATION
COMPLETED
COLLEGES/UNIVERSITIES CITY and STATE DATES Qtr Sem (BA/BS/
Hrs Hrs Major Hrs Minor Hrs MA/PhD) (Mo./Yr.)
ATTENDED
OTHER LANGUAGES SPOKEN: Sign Language
Type of License/Certificate License/Certificate Expiration Specialization/
Number (Mo./Yr.) Endorsements
Current Valid Commercial Driver’s License (CDL): Class (Check One): A B C
Teacher Certified in Georgia: Type of Certificate Held:
Other Professional License/Certificate:
CERTIFICATION: Read carefully before signing and dating. Incomplete and/or unsigned applications will
not be processed. I certify that all information on this application is correct. I authorize any agent or employee of the
State to verify this information and to release it to anyone who may consider me for appointment. I understand that
intentionally providing false information on this form or attachments is a violation of state law. I also understand that
applications submitted electronically, via e-mail or similar media, are not valid unless I enter my name in the
signature field below and such action shall constitute an electronic signature. I further certify that either: 1) I
have not been convicted of a drug-related criminal offense; or 2) if I have been convicted of a drug-related criminal
offense, it has been more than three (3) months since my first conviction, or more than five (5) years since a second or
subsequent conviction (O.C.G.A. 45-23 et. Seq.).
Signature: Date:
GA DOD State Personnel Office Page 1 August 2011 version

2. Applicant Name:
WORK HISTORY – ALL RELEVANT EXPERIENCE AND COMPLETE WORK HISTORY FOR THE PAST TEN YEARS:
Complete ALL fields. Include military and volunteer experience; explain any GAPS in employment. If you worked for the same employer
but held different jobs, describe each separately. Describe in detail the specific duties beginning with your primary duties. If you need
more space, print additional work history page(s) and attach to the application. Include additional documents as requested, such as the
DD214 member 4 copy. A resume may be attached but will not substitute for a completed application.
FAILURE TO GIVE COMPLETE AND DETAILED INFORMATION REGARDING EACH JOB HELD MAY RESULT IN
YOUR DISQUALIFICATION FROM EMPLOYMENT CONSIDERATION.
Current or Last Employer: Your Job Title:
Address From (mo/yr) To (mo/yr) Hours per Week:
City State Zip Code Check all that apply: Annual Salary
Volunteer Intern Paid
Your Supervisor’s Name and Title May We Contact Employer? Your Supervisor’s Phone Number
YES NO ( )
Reason for Leaving # and types of employees you supervised:
Describe in detail your job duties. (Attach additional pages or continue on back if necessary.)
Employer: Your Job Title:
Address From (mo/yr) To (mo/yr) Hours per Week:
City State Zip Code Check all that apply: Annual Salary
Volunteer Intern Paid
Your Supervisor’s Name and Title May We Contact Employer? Your Supervisor’s Phone Number
YES NO ( )
Reason for Leaving # and types of employees you supervised:
Describe in detail your job duties. (Attach additional pages or continue on back if necessary.)
Employer: Your Job Title:
Address From (mo/yr) To (mo/yr) Hours per Week:
City State Zip Code Check all that apply: Annual Salary
Volunteer Intern Paid
Your Supervisor’s Name and Title May We Contact Employer? Your Supervisor’s Phone Number
YES NO ( )
Reason for Leaving # and types of employees you supervised:
Describe in detail your job duties. (Attach additional pages or continue on back if necessary.)
GADOD State Personnel Office Page 2 August 2011 version

3. Applicant Name:
CONTINUED WORK HISTORY
Employer: Your Job Title:
Address From (mo/yr) To (mo/yr) Hours per Week:
City State Zip Code Check all that apply: Annual Salary
Volunteer Intern Paid
Your Supervisor’s Name and Title May We Contact Employer? Your Supervisor’s Phone Number
YES NO ( )
Reason for Leaving # and types of employees you supervised:
Describe in detail your job duties. (Attach additional pages or continue on back if necessary.)
Employer: Your Job Title:
Address From (mo/yr) To (mo/yr) Hours per Week:
City State Zip Code Check all that apply: Annual Salary
Volunteer Intern Paid
Your Supervisor’s Name and Title May We Contact Employer? Your Supervisor’s Phone Number
YES NO ( )
Reason for Leaving # and types of employees you supervised:
Describe in detail your job duties. (Attach additional pages or continue on back if necessary.)
*** Attach additional work history pages if needed ***
MILITARY SERVICE NOT LISTED ABOVE: Have you ever served in the United States Military?
Yes (please complete below) No (skip this section)
Branch From To Type of Discharge
(MM/DD/YYYY) (MM/DD/YYYY) ** if not honorable – please explain
GADOD State Personnel Office Page 3 August 2011 version

4. Applicant Name:
EQUAL EMPLOYMENT OPPORTUNITY INFORMATION
The information you give in this section is optional. It is used by the Georgia Department of Defense to comply with
Federal guidelines for monitoring the equal employment opportunity efforts of the State of Georgia.
Date: Announcement Number:
Ethnic Background (Check One): Gender Birth Date
American Indian White, not of Hispanic origin (Check One): MO DAY YR
Hispanic Black, not of Hispanic origin Male
Asian/Pacific Islander Multi-racial Female Birth Date - Required for
some law enforcement
jobs.
For Agency Use
GADOD State Personnel Office Page 4 August 2011 version