Job Application: Data Services Subject Matter Expert

Title: Data Services Subject Matter Expert

Fields marked with an asterisk (*) must be filled out before submitting.

Applicant Information

First Name *
Last Name *
Middle Name *
Date of Birth
Date Available *
Desired Wage

Contact Details

Address *
City *
State *
Zip Code *
Telephone
Cell phone
Email *

Security Clearance

Do you have a Clearance? Yes
No
If YES, what type?
Are your clearances active? Yes
No

Background Information

Are you a citizen of the United States? * Yes
No
If no, are you authorized to work in the U.S.? * Yes
No
Have you ever worked for GINIA before? Yes
No
If you have worked for GINIA in the past, when?
Have you ever been convicted of a felony? * Yes
No

Military Service

Have you served in the military before or are currently in active service? Yes
No
If Yes, please write years of service
Branch
Rank
Discharged? Yes
No

Training/Certification or Other Accomplishments

Please list relevant training
Please list relevant certifications
Other

Education

High School Name
Address
Years attended
Did you graduate? Yes
No
If NO, did you receive a GED or equivalent? Yes
No
College or University Name
Address
Years Attended
Did you graduate? Yes
No
If YES, what type of degree/major?
Advanced Degree? (i.e. Masters of Doctorate) Yes
No
University name & address
Years Attended
Did you graduate?
If YES, what type of degree/major?

Employment History (List most recent employment first)

Company Name #1
Address
Phone Number
Job Title
Starting Wage ($)
Ending Wage ($)
Duration of Employment
Full-Time Employee? Yes
No
Reason for leaving?
May we contact your previous supervisor for reference? Yes
No
Name of Supervisor
Supervisor phone number (business or personal)
 
Company Name #2
Address
Phone Number
Job Title
Starting Wage ($)
Ending Wage ($)
Duration of Employment
Full-Time Employee Yes
No
Reason for leaving?
May we contact your previous supervisor for reference? Yes
No
Name of supervisor
Supervisor phone number (business or personal)
 
Company name #3
Address
Phone Number
Job Title
Starting Wage ($)
Ending Wage ($)
Duration of Employment
Full-Time Employee? Yes
No
Reason for leaving?
May we contact your previous supervisor for reference? Yes
No
Name of Supervisor
Supervisor phone number (business or personal)

References (Professional only – minimum 2 from supervisors)

Full name *
Phone Number *
Relationship *
 
Full Name *
Phone Number *
Relationship *
 
Full Name
Phone Number
Relationship
 
Full Name
Phone Number
Relationship
 
Full Name
Phone Number
Relationship
Resume
* I attest to all the information inputted into this application to be accurate and up to date.
 
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